Is EmCare owned by Betsy DeVos?
7
Under lawyers' ethics rules "A lawyer or law firm shall not share legal fees with a nonlawyer." Perhaps doctors should operate under similar rules, "A doctor or medical practice shall not share fees with a non-doctors." That might take some of the corporate greed out of medical care.
7
This is so typical American. Greed comes before providing basic societal needs. This aystem is dysfunctional and abnormal. Much of Europe, Canada and even Israel are examples where efficient, quality health-care is provided at a *fraction of the cost*.
Tragically, America is falling behind and its leaders aren't good enough to save it.
Tragically, America is falling behind and its leaders aren't good enough to save it.
15
What I hope everyone here realizes is that in many cases a corporate contract group like EmCare is brought in by a hospital administration not because they can't find doctors, but because they can save money on the deal. They get the contract at a discount that private physician groups can't (won't) compete with, then EMCare comes in to rip off the community and make up the difference. This is a well known and oft used tactic to improve hospital margins. There is complicity by hospital executive teams around the country in this fiasco. Don't believe the "we cant find doctors" story. If EmCare can find them, they're out there.
But wait, it gets worse. Not only do you get billed more to save a few bucks for the hospital, but you will get inferior care. Another way corporate groups like EmCare, TeamHealth and US Staffing make a profit is by reducing the cost of staffing by using fewer and/or under trained providers. Your child may be seen for a seizure or meningitis by a physician's assistant fresh out of their basic 2-year training program or a non-ER trained doctor. Cheap labor, long hours and under-staffing. The work environment under these contract groups is hell - one reason why the number of ER doctors in the US is dwindling as most are forced out into early retirement.
ACEP is now a corporate mouthpiece. They no longer represent non-corporate doctors. Recognize this when you hear them defending this unconscionable practice.
But wait, it gets worse. Not only do you get billed more to save a few bucks for the hospital, but you will get inferior care. Another way corporate groups like EmCare, TeamHealth and US Staffing make a profit is by reducing the cost of staffing by using fewer and/or under trained providers. Your child may be seen for a seizure or meningitis by a physician's assistant fresh out of their basic 2-year training program or a non-ER trained doctor. Cheap labor, long hours and under-staffing. The work environment under these contract groups is hell - one reason why the number of ER doctors in the US is dwindling as most are forced out into early retirement.
ACEP is now a corporate mouthpiece. They no longer represent non-corporate doctors. Recognize this when you hear them defending this unconscionable practice.
16
". Why should a 65-year-old billionaire get FREE Medicare while a poverty-stricken 64-year-old gets basically NOTHING?"
why do you even care?
taking medicare away from billionaires will not solve the financial problems surrounding medicaid and medicare.
to say "while a poverty-stricken 64-year-old gets basically NOTHING?" is just plain not true. hospitals are required to treat everyone who walk into their doors. as this article reads emergency rooms are fast becoming profit centers
for hospitals.
why do you even care?
taking medicare away from billionaires will not solve the financial problems surrounding medicaid and medicare.
to say "while a poverty-stricken 64-year-old gets basically NOTHING?" is just plain not true. hospitals are required to treat everyone who walk into their doors. as this article reads emergency rooms are fast becoming profit centers
for hospitals.
2
The problem is much more complex then is poorly written article makes it out to be. The article illustrates only one side of the equation. Physician reimbursement per case has been decreasing for most specialties, If we are in network the insurance companies pay us 1/10th of what they pay if we are out of network. Also, if you have a balance bill and are going to a in network physician, we can not waive that balance. However, if you go to a out of network physician and approach the physician about waiving the balance, the physician can waive the balance.
This has nothing to do with a physician being greedy, it has to do with the insurance companies trying to maintain their profit margins by charging the public higher premiums and decreasing the payout to physicians, which increases their margins.
I agree that a single payer system will alleviate most of these issues, but please do not make ER physician out to be the greedy docs.
ER docs take care of most of the uninsured population in the United States, more then any other specialty. We see ANYONE who comes through our doors, there is no receptionist at the desk asking to see your insurance information before you get a appointment with the physician. We are the true community physicians and are the only safety net of the entire health system
This has nothing to do with a physician being greedy, it has to do with the insurance companies trying to maintain their profit margins by charging the public higher premiums and decreasing the payout to physicians, which increases their margins.
I agree that a single payer system will alleviate most of these issues, but please do not make ER physician out to be the greedy docs.
ER docs take care of most of the uninsured population in the United States, more then any other specialty. We see ANYONE who comes through our doors, there is no receptionist at the desk asking to see your insurance information before you get a appointment with the physician. We are the true community physicians and are the only safety net of the entire health system
7
Yes, but what happens when I choose the ER of a hospital in my network specially to manage costs and then get a bill for $2,000 from a physician working in that ER that is out of network? This actually happened to me. To say the bill was a shock is an understatement. You taken away my ability to shop around for the cheapest care, the Republican mantra , because there is no disclosure that the ER physician is out of network.
8
it is the usual,. the middle class gets shafted from every direction, because they will squeak the least. the "poor" pay nothing for health care. the rich will get cadillac insurance, congressional members take care of their own.
6
How do these people sleep at night??
5
As an ex contact negotiatar for doctors, their excuse is ridiculous. All doctors know that when they join a practice or hospital they have to be credentialed. This ignorance is by choice. .
4
It is the same all over the country.
To a degree this was brought about by the insurance companies themselves by reducing the in network rate for individual doctors to a point so low that it was not possible for them to just survive. All in the name of "what the market will bear."
Let me give you two examples from Long Island :
First, did you ever wonder why your own doctor is not there in the hospital to see you when one gets admitted to the hospital ? Started in early 2000, most primary care physicians used to do hospital rounds, the reimbursement rate fell below $50 per visit if you are in network. Physicians cannot survive if they are out of network and need to see patients in the office. A typical physician saw 5-6 admitted patients in the morning and went back to the clinic and saw other patients. Then the hospitalist groups realized that if they are out of network, can bill $ 500 for the same encounter. So, they hired out of network hospitalists who will just see 6-10 patients and generate enough revenue to the point that very few new graduates want to do the traditional 5-6 days of practice, get paid less and have no bonuses.
Now everyone does 7 on 7 off, or 12/3 or 10/4 shifts and be done. Same is happening now with outpatient practices that are merging with hospitals. Hospital doctors get paid more for the same work than community doctors. Can the society afford it ? I know doctors cannot afford to keep their practices open.
Same story with general surgeons.
To a degree this was brought about by the insurance companies themselves by reducing the in network rate for individual doctors to a point so low that it was not possible for them to just survive. All in the name of "what the market will bear."
Let me give you two examples from Long Island :
First, did you ever wonder why your own doctor is not there in the hospital to see you when one gets admitted to the hospital ? Started in early 2000, most primary care physicians used to do hospital rounds, the reimbursement rate fell below $50 per visit if you are in network. Physicians cannot survive if they are out of network and need to see patients in the office. A typical physician saw 5-6 admitted patients in the morning and went back to the clinic and saw other patients. Then the hospitalist groups realized that if they are out of network, can bill $ 500 for the same encounter. So, they hired out of network hospitalists who will just see 6-10 patients and generate enough revenue to the point that very few new graduates want to do the traditional 5-6 days of practice, get paid less and have no bonuses.
Now everyone does 7 on 7 off, or 12/3 or 10/4 shifts and be done. Same is happening now with outpatient practices that are merging with hospitals. Hospital doctors get paid more for the same work than community doctors. Can the society afford it ? I know doctors cannot afford to keep their practices open.
Same story with general surgeons.
7
Any wonder why the cost of healthcare in the USA is so high? This is just one example. Congress better do something to control overpayments to doctors, hospitals, Big Pharma, medical supply and equipment companies, rehab programs, mental health professionals, etc. We are not getting our money's worth in health care and are being ripped off every day. Most people don't notice or care because the taxpayers are footing the bill. I support universal health care, at least for catastrophic illnesses like AIDS, cancer, heart disease, etc, for ALL citizens of the USA. There should be deductibles and co-pays in the new plan to force us to feel a little financial pain so we won't abuse the generous health care benefits we receive under Medicare, Medicaid, union plans, and corporate plans. The new health plan should charge us premiums based on income, on our ability to pay. Call it "KennedyCare" in honor of our late US Senator from Massachusetts, Edward M. Kennedy, who fought long and hard for many years for universal health care for all Americans. Why should a 65-year-old billionaire get FREE Medicare while a poverty-stricken 64-year-old gets basically NOTHING?
3
Ask John McCain. He is why.
1
As a board certified emergency medicine trained physician, I have read many of these comments and need to clear a few things up.
People saying we are greedy? I gave up 4 years of income (and added to my student loan debt) while in medical school. Worked for an average $14.35/hr for 3 years taking care of patients as a resident - as physicians we put our lives on hold to take care of you and your family. ED physicians work holidays, weekends, nights. I would like to see you get scheduled to work Christmas for the same pay you get for working July 25th.
A lot of the posters are complaining of bills from the ED for things like nosebleeds, sprained ankles, cough. These are things best handled by your PCP - oh wait, you can't wait until their office is open. You pay for convenience.
Our skill set is related to our ability to stabilize when you or your family member is dying. Emergency medicine physicians can breathe for you, restart your heart or re-expand your lung. I can even cut open your chest and sew up a hole in your heart or I can deliver your child. Be thankful that we exist and are willing to spend our holidays, birthdays, anniversaries caring for your family while missing out on our family's events.
I will bet that in/out of network doesn't matter to you when it comes down to you or your family living or dying. But if it does matter, tell us to stop CPR on your child. Tell us not to call the cath lab for your heart attack. But in the end, I bet you won't.
People saying we are greedy? I gave up 4 years of income (and added to my student loan debt) while in medical school. Worked for an average $14.35/hr for 3 years taking care of patients as a resident - as physicians we put our lives on hold to take care of you and your family. ED physicians work holidays, weekends, nights. I would like to see you get scheduled to work Christmas for the same pay you get for working July 25th.
A lot of the posters are complaining of bills from the ED for things like nosebleeds, sprained ankles, cough. These are things best handled by your PCP - oh wait, you can't wait until their office is open. You pay for convenience.
Our skill set is related to our ability to stabilize when you or your family member is dying. Emergency medicine physicians can breathe for you, restart your heart or re-expand your lung. I can even cut open your chest and sew up a hole in your heart or I can deliver your child. Be thankful that we exist and are willing to spend our holidays, birthdays, anniversaries caring for your family while missing out on our family's events.
I will bet that in/out of network doesn't matter to you when it comes down to you or your family living or dying. But if it does matter, tell us to stop CPR on your child. Tell us not to call the cath lab for your heart attack. But in the end, I bet you won't.
15
Still no excuse.
5
This is akin to a pilot asking the passengers for more money when the plane is landing and threatening to take his hands off the wheel. I am embarrassed to be in the same profession as you.
16
I believe there needs to be a national law to outlaw surprise billing. I have health insurance from New York State but live in Florida. Both states have surprise billing laws. The law in New York only applies to care received in New York. The law in Florida only applies to those who have insurance with a Florida based company. I recently was hospitalized for an emergency situation . I received two bills and was told that these were out-of-network expenses. The billing group refused to negotiate the bill and insisted that it be paid in full. Since the surprise billing laws in neither of the so states applies to me I had no choice but to pay the bill.
2
Health care reform should include transparency regarding these contracts - Tragic that this study is not being discussed in the Senate TODAY, rather than so much secrecy.
EmCare's website lists the 59 pages of hospitals seeking new ER physicians; obviously they continue to negotiate alot of these high payout contracts.
23,100 employed currently in 45 states!
Envision's 2016 Annual report: Emergency service and hospitalist providers handled more than 15.2 million emergency room visits in 41 states. Anesthesia professionals handled more than 2.4 million anesthetic cases in 26 states.
Keep supporting the NY Times., as they are a beacon for concise data reporting.
EmCare's website lists the 59 pages of hospitals seeking new ER physicians; obviously they continue to negotiate alot of these high payout contracts.
23,100 employed currently in 45 states!
Envision's 2016 Annual report: Emergency service and hospitalist providers handled more than 15.2 million emergency room visits in 41 states. Anesthesia professionals handled more than 2.4 million anesthetic cases in 26 states.
Keep supporting the NY Times., as they are a beacon for concise data reporting.
4
I'm on a Medicaid Advantage plan through NYSOH. I've actually become afraid to visit relatives in other states, because I think I'd be exposed to getting these bills if, God forbid, I ever wound up in the ER with such crummy insurance. (I own my home, so it would be worth a debt collector's while to go after me for payment.) I can't get the straight truth about it from either my insurer or NYS, so I don't know how to protect myself other than by staying home. This system is so broken!
4
It would be helpful if the Times could publish a list of EmCare hospitals to help consumers know where to avoid.
17
Exhibit A for Single Payer
16
The Big Emergency Room Scam. You go to your favorite in-network hospital with your kid who has a cut. You wait two hours, the kid gets one stitch and you get a bill from the ER docs for $800. Sorry says the insurance company we can't help: they're not in our network. The ER docs bill department is very helpful: pay cash now and we'll settle for $400. Thank God it wasn't two stitches. BTW a nurse put in the stitch according to the bill there was an ER doc somewhere in the vicinity who was supervising... you could have fooled me... and maybe they did. The hospital and the ER docs should be ashamed of themselves.
14
why not go to small claims court? there has to be a solution here.
2
The company is a predator abusing the loopholes in the healthcare system. Their management should be named (a weakness of this article) and shamed, and if possible brought to court.
10
Shame on this management:
Christopher A. Holden, President and Chief Executive Officer
William A. Sanger, Executive Chairman and Director
Claire M. Gulmi, Executive Vice President and Chief Financial Officer
Robert J. Coward, Executive Vice President and President - Physician Services
Randel G. Owen, Executive Vice President and President - Ambulatory Services Group
Patrick B. Solomon, Senior Vice President and Chief Strategy Officer
Christopher A. Holden, President and Chief Executive Officer
William A. Sanger, Executive Chairman and Director
Claire M. Gulmi, Executive Vice President and Chief Financial Officer
Robert J. Coward, Executive Vice President and President - Physician Services
Randel G. Owen, Executive Vice President and President - Ambulatory Services Group
Patrick B. Solomon, Senior Vice President and Chief Strategy Officer
15
There is nothing in Obamacare/ACA that causes or prevents the ability to charge patients the full fee for doctors/ hospital or ER services if they are not contracted with your insurance. Stop blaming Obamacare for the preexisting flaws in our health care system. Any of you who thought that a health plan that supports the use of the private insurance system, would lower costs have been deceived. How without limiting prices and rates could that occur? Suckers get a clue!
8
Imagine if all the wasted energy and money of Republicans fighting healthcare for all for 100+ years, had been spent on making the US strong with education and jobs.
13
This sounds like a fraudulent if not criminal scheme worthy of investigation under RICO 18 USC 1961 et seq. The US Attorney's Office and the states Attorney Generals should get involved in this one. Private individuals may sue under 18 USC 1964 for treble damages and counsel fees.
12
Just another impact of Obamacare.
2
WAH, this problem was pre Obamacare and doesn't look like this issue will change with the AHCA either. Get real. Health care in the US is anything but transparent and until that changes, we can all be taken advantage of, and with little recourse.
11
On the Patient Consent form they want you to sign, insert in large caps, "TREATMENT BY OUT OF NETWORK PROVIDERS NOT AUTHORIZED. NO PAYMENT WILL BE MADE FOR SUCH SERVICES".
18
First time dealing with the medical system in the States, a 12-min visit to get 2 pills while traveling (forgot my pills, Elavil, non-addictive). Was told they could not bill me immediately because they did not know how much it would be - WHAT? "But it would be around $300" to be weighed, blood pressure taken and have a 10 minute consult with a physician's assistance. What other industry works behind this opaque and ridiculous curtain? There is nothing "free market" about the provision of medical services in the States - it's a convoluted, extortionist mess.
33
One wonders if complaints to the Consumer Financial Protection Bureau is not in order over the scams involved in Medical Billing in the United States.
Disputed Medical Bills can trash your credit report even if your insurance company is the one doing the dispute. Consumers can get caught up in a blizzard of paperwork, medical coding, pre-approval, denied claims and demands for immediate payment of bills disputed by a carrier. I found out personally when an outpatient visit to a doctor listed as in network on our Insurance Carrier's website turned out inaccurate and they denied the claim. The aggressive billing by the clinic had already submitted to the credit reporting bureaus before I had even been notified the claim was denied. Anything that impacts a Credit Rating adversely could impact your ability to get hired, get a promotion, rent an apartment, obtain a Car or Home loan, etc.
In what other consumer facing business is it acceptable to charge 4 different patients 4 different prices for the same treatment at the same facility by the same staff? Add in that many times Emergency Care is rendered at hospitals that are the only geographic option with no competition to hold pricing in check. If you are hurt or sick and need care you will use the nearest ER even if they are known to gouge patients on pricing.
So much of the business side of healthcare in the US is seedy and unseemly.
Disputed Medical Bills can trash your credit report even if your insurance company is the one doing the dispute. Consumers can get caught up in a blizzard of paperwork, medical coding, pre-approval, denied claims and demands for immediate payment of bills disputed by a carrier. I found out personally when an outpatient visit to a doctor listed as in network on our Insurance Carrier's website turned out inaccurate and they denied the claim. The aggressive billing by the clinic had already submitted to the credit reporting bureaus before I had even been notified the claim was denied. Anything that impacts a Credit Rating adversely could impact your ability to get hired, get a promotion, rent an apartment, obtain a Car or Home loan, etc.
In what other consumer facing business is it acceptable to charge 4 different patients 4 different prices for the same treatment at the same facility by the same staff? Add in that many times Emergency Care is rendered at hospitals that are the only geographic option with no competition to hold pricing in check. If you are hurt or sick and need care you will use the nearest ER even if they are known to gouge patients on pricing.
So much of the business side of healthcare in the US is seedy and unseemly.
7
I'm a practicing primary care physician for almost 30 yrs and well versed in the business of medicine. These ER groups are gaming the system and are being exposed. Most doctors and hospitals have our collectible fees limited by our agreed rates with insurers. The hospitals who contracted with EMcare did not realize that EMcare was not contracted with the major private insurers in their markets and erroneously assumed that they were. If you aggressively work up a problem like "chest pain"-- that you (the ER doc) know is unlikely to be from an acute cardiac problem or blood clot to the lungs-- you can charge the highest level on all patients with "chest pain". You the patient will think they were so thorough and that you got the best care-- until you get Emcare's out of network bill. These exploitative practices are part of the problem and help explain why you will never see healthcare cost go down under the Obamacare or any other plan that does not restrict these practices or change from the fee for service system of reimbursement.
19
Now this is the type of everyday problem the Democrats should be speaking to in the Better Deal. Rather than broad-stoke, yawn-inducing proposals such as non-defined job training programs (for what kind of jobs?; training by whom?), the Democrats should be saying that when they are back in power, surprise out-of-network bills and similar fleeces of ordinary Americans will be a thing of the past because they'll be made illegal. It's not that hard. Democrats need to address economic injustices head on without fear of retribution from their corporate campaign contributors. Their proposals were nothing if not careful - must not offend the big money.
9
Years ago I knew the attending physician at Stamford Hospital, a cardiologist, was out of network. What I did not realize was the systematic corruption of the ER's in our nation's hospitals. When someone is taken to a local ER by an ambulance, thanks to a "good Samaritan's " call, and has no choice over the care given, you would hope the care given would be in the best interests of the patient. Why is there no "Fiduciary Standard" in health care?
19
There it is - private profit is the only thing middle-men corporations are interested in.
Single-payer seems to be the solution you are looking for.
Single-payer seems to be the solution you are looking for.
12
Out of network billing = legalized robbery.
Let's don't give it any other name!
Let's don't give it any other name!
9
I find it deliciously ironic that the NYT opts to publish this on the day that the US Senate is poised to send millions of people into the maws of companies like EmCare around the country when their only option will be an ER for an ear ache if the US Senate repeals the ACA.
10
About 6 months after gall bladder surgery I received a "bill" from an out-of-network doctor for "assistance during surgery." I sent the bill back with the following note: I don't know who you are or why you are sending this bill, but I'm not paying. I never heard from him again.
I am not suggesting patients don't pay for care, but we need as consumers to stand up for ourselves and not just cower in fear. There is strength in numbers and right now we ALL need to speak up about this health fiasco we are facing-ridiculous costs, insurance fraud and poor care.
I am not suggesting patients don't pay for care, but we need as consumers to stand up for ourselves and not just cower in fear. There is strength in numbers and right now we ALL need to speak up about this health fiasco we are facing-ridiculous costs, insurance fraud and poor care.
10
Beware Ann Arbor & Washtenaw County residents (and 1 million Midwesterners): EPMG (Emergency Physicians Medical Group) sold to EmCare in 2016. Examine your bills and ask questions up front. Secret deals and surprise billings could bankrupt you.
State legislation forced crooked car repair shops to be more transparent. Consumers deserve at least the same transparency in health care.
State legislation forced crooked car repair shops to be more transparent. Consumers deserve at least the same transparency in health care.
11
Somebody (I forgot who) once said, 'The business of America is - business.'
3
Stupid, insane system that allows this to happen. Another example of why the medical industry should not be a for profit industry. A single payer medical system would totally eliminate this. Presently greed is the driving factor, and is why doctors and clinics, hospitals, bill high, take what they can get away with.
The american way.
The american way.
7
This is another reason that you should only use the ED in cases of very serious emergency. Save the nose bleed, the rash, the sunburn, the fever, for the Family Doctor, or a Med-First Clinic.
5
For those who say I won't go to a hospital that uses Emcare, that still does not solve this problem. What happens when you go to the ED and the doctor who treats you is a "locums" filling in for someone on vacation and that doctor is not "in-network?" Using "locums" happens every day as hospitals don't have the staff to fill their needs at all times. So then that doctor, who is from another state or country, sees you, you get billed for an "out of network" doctor. The insurance company can fix this problem IF they wanted to.
1
Obviously Emcare and the like should simply salary their needy doctors, so that the doctors do not scam the patients. Hospitals should only contract with salaried workers.
22
I wonder how much the executives who run EmCare get paid annually and what the return is to stockholders, none of whom contribute one bit to the welfare of patients!
10
Privatization and deregulation, when you hear those 2 words lock up your money tight.
8
EmCare in their marketing brochure to the hospitals:
EmCare. The Em means Extra Money for you.
EmCare - Putting earnings first.
Another company putting earnings above patient care.
EmCare. The Em means Extra Money for you.
EmCare - Putting earnings first.
Another company putting earnings above patient care.
7
We got a surprise hit with an a bill for an "out of network" anesthesiologist who was brought in by the "in network" hospital clinic and doctor for a recent procedure for my wife. It wasn't cheap.
What we did do is challenge it by asserting that we weren't told that a non-network gas passer was being brought into our network hospital. Not knowing this did ot enable us to make an informed decision about going through with it. Insisting and persisting that the hospital surely had their anesthesiologists to do the work rather than bringing one from another team. We got the charge waived in cooperation with her pre-Medicare insurance. Finally, we insisted that going forward the hospital make bloody sure that all players are "in network". The squeaky wheel worked in this case. Unfortunately, there may be less luck in dealing with something as big as ER doctor, med and service bills.
Single payer for all!
What we did do is challenge it by asserting that we weren't told that a non-network gas passer was being brought into our network hospital. Not knowing this did ot enable us to make an informed decision about going through with it. Insisting and persisting that the hospital surely had their anesthesiologists to do the work rather than bringing one from another team. We got the charge waived in cooperation with her pre-Medicare insurance. Finally, we insisted that going forward the hospital make bloody sure that all players are "in network". The squeaky wheel worked in this case. Unfortunately, there may be less luck in dealing with something as big as ER doctor, med and service bills.
Single payer for all!
10
EMCare is a very bad actor. You should interview docs who have been in hospitals before EMCare got the contract and have them tell you what happened after. EMCare is solely profit driven, docs who don't follow their rules are let go. Hospitals should stop contracting with them, period.
6
Emcare is the bucket shop of healthcare. Operating like a boiler room sales group, they prey on the vulnerable. If the Times can release the names of top American spies operating in foreign countries, why can't you get names of the Emcare group and call them out.
5
Who can trust a company that can't even spell the word "payers"?!
"In a statement, EmCare ... acknowledged that surprise billing ... is 'a source of dissatisfaction for all payors, providers and patients in our current health care system.'"
And, that ignores the Oxford (serial) comma?! LOL!
Hmm... "surprise billing is a source of dissatisfaction". No kidding!
Worse, of course, is that EmCare disavows that it is responsible for the "surprise" billing it inflicts!
Maybe its phrase "current health care system" was a Freudian slip!
Under single-payer and a national health service, we'd eliminate EmCare and similar outfits and do away private insurance altogether!
"In a statement, EmCare ... acknowledged that surprise billing ... is 'a source of dissatisfaction for all payors, providers and patients in our current health care system.'"
And, that ignores the Oxford (serial) comma?! LOL!
Hmm... "surprise billing is a source of dissatisfaction". No kidding!
Worse, of course, is that EmCare disavows that it is responsible for the "surprise" billing it inflicts!
Maybe its phrase "current health care system" was a Freudian slip!
Under single-payer and a national health service, we'd eliminate EmCare and similar outfits and do away private insurance altogether!
1
I'll vote for Emcare for the 2017 Shrkeli award.
4
EmCare sounds like the model for TrumpCare.
A friend of mine who is retired from the insurance business said the big problem is that everyone involved in medicine thinks they deserve to be a multi-millionaire. What used to be a good job has become a massive revenue source. Entitlement, with sick and injured people being held hostage.
A friend of mine who is retired from the insurance business said the big problem is that everyone involved in medicine thinks they deserve to be a multi-millionaire. What used to be a good job has become a massive revenue source. Entitlement, with sick and injured people being held hostage.
4
The controller of the hospitals should have found EmCare's fraud and questioned the company, utilized legal actions against them, etc. And this should have been done immediately.
1
Can we now agree that this is exactly why people do not get more excited about Obamacare (ACA)? It does not matter who pays the bill if the provider does not agree to the terms of the payer. High quality, ethical providers get asked to take paltry Medicaid reimbursements while groups like this look for every profitable opportunity. Insurance (even a public option or single payer) is not a strong enough lever unless the providers are required to accept it.
4
This is just one aspect of the mess created by our current system of delivering healthcare. So long as the emphasis is on health insurance, i.e. payment for care, and not care itself, there can be no genuine solution. The "old model", regardless of how it is fine tuned, is no longer viable. Any alternative will, of course, have problems that will need to be ironed out. But, we can't keep patching up the current one. Bottom line, the best replacement wouild be a single-payer, universal system.
9
As an ER physician who has worked for EmCare, as well as a father who has had to pay for surprise out-of-network ER charges which were exorbitant, I feel I have a good perspective on this problem.
Each time a new contractor takes over the management of the ER physicians (and it happens not infrequently) the doctors have to sign up with each insurance carrier individually. This often means signing a dozen different contracts. Obviously, when a temporary or new doctor works in the ER, those contracts may not have been signed, and the doctor is out-of-network. This is a billing problem, not a treatment problem, and I blame it on the insurance companies (another good argument for single payer healthcare).
Any contractor has to staff the ER 24/7 according to its contract with the hospital. There are no exceptions. If the contractor has a problem with a rural hospital they may have to bring in physicians from outside the area; this is not a fault or defect, but it is a fact of life. There are a number of good reasons why there is physician turn-over at this time. It is inevitable.
EmCare is very assiduous in its billing practices. They feel they should bill at the appropriate level, and work hard to see that this is accomplished. Mainly this means better documentation of the chart in ways that have developed over the years so as to meet the guidelines set up by insurance companies. This is a fault of insurance.
Each time a new contractor takes over the management of the ER physicians (and it happens not infrequently) the doctors have to sign up with each insurance carrier individually. This often means signing a dozen different contracts. Obviously, when a temporary or new doctor works in the ER, those contracts may not have been signed, and the doctor is out-of-network. This is a billing problem, not a treatment problem, and I blame it on the insurance companies (another good argument for single payer healthcare).
Any contractor has to staff the ER 24/7 according to its contract with the hospital. There are no exceptions. If the contractor has a problem with a rural hospital they may have to bring in physicians from outside the area; this is not a fault or defect, but it is a fact of life. There are a number of good reasons why there is physician turn-over at this time. It is inevitable.
EmCare is very assiduous in its billing practices. They feel they should bill at the appropriate level, and work hard to see that this is accomplished. Mainly this means better documentation of the chart in ways that have developed over the years so as to meet the guidelines set up by insurance companies. This is a fault of insurance.
6
I am not sure if you've read the testimonials from many MDs on this board documenting the needless exams, routine overbilling and price gouging by EmCare.
The fact that the company had nothing to say to the writer (I am sure they were asked) says it all. We are talking about legal racketeering, a company led by unscrupulous businessmen out to make a buck.
The fact that the company had nothing to say to the writer (I am sure they were asked) says it all. We are talking about legal racketeering, a company led by unscrupulous businessmen out to make a buck.
6
This article is very unclear and misleading in one regard, Emergency Room Physician Pay. ER Docs are paid an hourly rate through staffing firms like EM Care and Team Health. They are NOT paid any monies based off of the staffing companies billing.
ER docs sign up to do a job they love with brutal hours and working conditions for a flat fixed hourly rate. The ER doc isn't in charge of billing or what insurance companies are partnered with which staffing companies. This isn't their job. Let's be clear about one thing the job of an ER doc is to save a life in an emergent situation.
ER docs sign up to do a job they love with brutal hours and working conditions for a flat fixed hourly rate. The ER doc isn't in charge of billing or what insurance companies are partnered with which staffing companies. This isn't their job. Let's be clear about one thing the job of an ER doc is to save a life in an emergent situation.
14
My wife and I are both recently retired physicians. I was a psychiatrist and she was an ER physician. Over the last 25 years we both could clearly see that medicine in the US was no longer about caring for other humans but was becoming s huge profit machine for companies like EmCare. And EmCare is not the only one. There are many, many more. As a physician, you are ordered to do as many labs, imaging, over-diagnosing and over-testing and over-prescribing as possible. If you don't, they fire you.
Since these companies are in cahoots with politicians, hospitals and BigPharma they control everything.
Here's the REALLY bad news. It's getting worse, will continue to get worse and is unstoppable.
That is why we retired and are moving to Europe.
Medical care in the US is completely out of control and no one can stop them. The companies, like EmCare slash employees, substitute real doctors with PA's and ARNP's whom they pay half as much as MD's and pay their CEO's tens of millions of dollars.
They don't care about the patients, they don't follow normal procedures, they don't care about anything except stealing as much money as they can from people who are suffering. They are vampires, ghouls, evil.
In other words, they represent what the US has become. A sick, deadening culture that only values one thing. MONEY.
Since these companies are in cahoots with politicians, hospitals and BigPharma they control everything.
Here's the REALLY bad news. It's getting worse, will continue to get worse and is unstoppable.
That is why we retired and are moving to Europe.
Medical care in the US is completely out of control and no one can stop them. The companies, like EmCare slash employees, substitute real doctors with PA's and ARNP's whom they pay half as much as MD's and pay their CEO's tens of millions of dollars.
They don't care about the patients, they don't follow normal procedures, they don't care about anything except stealing as much money as they can from people who are suffering. They are vampires, ghouls, evil.
In other words, they represent what the US has become. A sick, deadening culture that only values one thing. MONEY.
27
The system of having out of network doctors in in network hospitals is unfair but I would also like to bring up the fact that many people use emergency rooms as urgent care facilities and do not check prices for tests when they can. The system does not make it easy and it is frustrating (and should be unnecessary) but it can be done for most non-emergency tests.
Emergency rooms must stay open, lit, staffed and stocked 24/7 365 regardless of whether or not they have patients. Your doctor is closed nights, weekends and holidays so they can charge you less. There are basic economic principles at work here that can't be ignored notwithstanding the immoral actions of these third party companies. No, healthcare should not be a business but for now, it is.
Emergency rooms must stay open, lit, staffed and stocked 24/7 365 regardless of whether or not they have patients. Your doctor is closed nights, weekends and holidays so they can charge you less. There are basic economic principles at work here that can't be ignored notwithstanding the immoral actions of these third party companies. No, healthcare should not be a business but for now, it is.
5
Ditto! But I would add that insurers are equally guilty of turning healthcare into a greedy corporate medicine machine
2
"many people use emergency rooms as urgent care facilities and do not check prices for tests when they can. The system does not make it easy and it is frustrating (and should be unnecessary) but it can be done for most non-emergency tests."
Have you ever tried to find the price of a test at an emergency room (or urgent care or just about any medical facility for that matter)? They tell you that they don't know, they won't know until afterward. The billing is often done by people in a different building, sometimes even a different state.
And if you were given a price for the tests, you're in a difficult position if the cost is high and the doctor says you must have it done. Are you going to overrule their expertise and be seen as a "bad patient"? Good luck getting them to explain each test they ordered as they genuinely don't have the time to do that.
Have you ever tried to find the price of a test at an emergency room (or urgent care or just about any medical facility for that matter)? They tell you that they don't know, they won't know until afterward. The billing is often done by people in a different building, sometimes even a different state.
And if you were given a price for the tests, you're in a difficult position if the cost is high and the doctor says you must have it done. Are you going to overrule their expertise and be seen as a "bad patient"? Good luck getting them to explain each test they ordered as they genuinely don't have the time to do that.
1
Another little medical racket gets some exposure!
2
"Insurers and health care providers typically sign contracts forbidding them to reveal the prices they have agreed to..." The American consumer does not stand a chance in this profit-driven deregulated country.
7
I am all for single-payer but lets have an honest discussion. Single payer means all hospitals are government owned and all doctors work for the government. Private payments are prohibited! That is the Canadian system! Kaiser Permanente is similar!
Not true. I had private health insurance in Netherlands. I paid zero euros for my asthma checkup and medication. Here iam paying $250 as co-pay for medication alone. Call it what you may, but Netherlands is far better.
8
@Donna Gray
Louisa, Va
All Canadian hospitals are not government owned and all Canadian doctors do not work for the government.
Louisa, Va
All Canadian hospitals are not government owned and all Canadian doctors do not work for the government.
10
Please review your facts. Even in countries that have true national health care, millionaires can still pay for private care.
At Mayo Clinics, which are non-profit and where physicians are salaried, care is based on what is needed, not what provides the most profit for share holders.
At Mayo Clinics, which are non-profit and where physicians are salaried, care is based on what is needed, not what provides the most profit for share holders.
3
It's the surprise factor that makes healthcare so challenging. If my horse lacerated her leg, it triggers a call to vet for an after hours call, which is generally about a $200 farm call fee. Other diagnostics will be $200 or so (x-rays), exam $100, antibiotics, meds- maybe $150. So probably $500-$600 for what would be $1500 plus at an ER for pets, $2500 at an ER for people. And that includes the vet coming to her.
Maybe we need to make human medicine follow the pattern equine has- 75% of common simple issues are dealt with for a modest price, during a set appointment at your house. Emergency care has an extra fee. Anything more complex goes to major clinics and insurance generally kicks in.
A broken ankle could be dealt with using a portable X-ray machine (every vet has one), components to make a cast, NSAIDS and painkillers. That should be a $500-$1000 bill tops if it's simple. That's probably about what it would run for a horse with a rehabbable broken bone.
Maybe we need to make human medicine follow the pattern equine has- 75% of common simple issues are dealt with for a modest price, during a set appointment at your house. Emergency care has an extra fee. Anything more complex goes to major clinics and insurance generally kicks in.
A broken ankle could be dealt with using a portable X-ray machine (every vet has one), components to make a cast, NSAIDS and painkillers. That should be a $500-$1000 bill tops if it's simple. That's probably about what it would run for a horse with a rehabbable broken bone.
5
The only way out of this mess, is a single payer Health Care System. When every other 1st World Nation, has a Single Payer System, except the U.S. you have to ask WHY? When our elected Representatives are forced to participate in the the same system the rest of us have to live and die with, only then, will they have any real interest in seeing that we are all provided with a high quality single payer health care system and not a FOR PROFIT SYSTEM.
17
Here in the South, virtually every state is a so called "right to work" state. A joke of a name since all it means is antiunion and they'd rather lose an arm before letting every day workers and the little guys organize for better wages. None of this increasing the minimum wage above federal levels either. Somehow, evidently, it's fine and dandy for corporations to rig the system and gouge the little guys with abandon. Stuff like this and somehow they've managed to convince a significant portion of the population that regulations are a bad thing? Sure, always keep a foot on the peasants and keep telling them that.
10
When I received an ambush bill for about $700, from a physician who saw me for about five minutes, I protested to my insurance company, and they did pay all of this bill except for $56. The reason they did not pay the $56 was because this charge was for an EKG that was billed under the hospital's portion of the bill.
The physician group continue to hound me for this $56, and I explained to them why I was not going to pay it. They then sold this $56 bill to a collection agency--likely for about $5--and I had to explain to the collection agency why I was not going to pay it. They then sold it to another collection agency. I put an end to it when I informed the second agency that they could not sell this bill to another collection agency without informing them that it was under dispute. To say that I hate this country's health care system is an understatement. Greed, greed, and more greed. It never ends.
The physician group continue to hound me for this $56, and I explained to them why I was not going to pay it. They then sold this $56 bill to a collection agency--likely for about $5--and I had to explain to the collection agency why I was not going to pay it. They then sold it to another collection agency. I put an end to it when I informed the second agency that they could not sell this bill to another collection agency without informing them that it was under dispute. To say that I hate this country's health care system is an understatement. Greed, greed, and more greed. It never ends.
32
The profit motive in medicine is overtaking its primary reason for existence: patient care.
Where we live, the large area health systems have been opening many emergent care centers where basic care costs four times as much as the care at our local walk-in medical clinic that has been in operation for many years. These same health systems have been buying up specialist practices and consolidating them into important-sounding "institutes," where marketing is used to make patients believe they are getting better care at substantially higher prices.
Everyone's getting on the bandwagon, including my former dentist, who sends out flyers urging patients to make appointments not for necessary care, but to "use up" their dental insurance before the year is over.
Single-payer government healthcare won't solve any of this unless it comes with price controls and other restrictions imposed on all providers.
Where we live, the large area health systems have been opening many emergent care centers where basic care costs four times as much as the care at our local walk-in medical clinic that has been in operation for many years. These same health systems have been buying up specialist practices and consolidating them into important-sounding "institutes," where marketing is used to make patients believe they are getting better care at substantially higher prices.
Everyone's getting on the bandwagon, including my former dentist, who sends out flyers urging patients to make appointments not for necessary care, but to "use up" their dental insurance before the year is over.
Single-payer government healthcare won't solve any of this unless it comes with price controls and other restrictions imposed on all providers.
18
I have added signing statements when going to in network medical facilities that may have out of network doctors. In the area where you agree to pay all bills, I add "not to exceed what my insurance company will pay to in network doctors".
15
Does it work? Did they bill you anyway or change cars?
5
If you visit an ER, they don't answer the phone when you try to get payment assistance, and then they sell your information to debt collectors who also come after unrelated debts over 7 years old.
7
Great reporting and congrats to the Yale team for their hard work! This just highlights how medical care is not a free market. Health care should be regulated just the same way we regulate electrical utilities. The Democrats should add this to their list of egregious practices that are concentrating wealth at the top.
18
A perfect case study exemplifying why profit needs to be taken out of healthcare and why single payer will save money.
23
This is precisely what is wrong with privatization of health care. It pervades Medicare Part B, where doctors fix prices in collusion with private insurers, and Part D, where pharmaceutical companies and pharmacies fix prices without any involvement by government.
14
I had a mole removed (benign, thankfully) at an in-network dermatologist with pathology performed by an in-network pathologist, yet still received an out-of-network bill (how convenient for the insurance company as I was close to meeting my deductible). After many calls to the insurance company and doctor's office, I was informed that the tax ID for the company the pathologist billed to was not the tax ID that was registered for the in-network entity. (So now we have to be forensic accountants to acquire fair healthcare?) Flabbergasted, I appealed, but the insurance company denied the appeal. Ridiculous. We need single payer now, not this hopeless mess. At least with government-run single-payer system, I have a Congressperson, a Senator, a President, etc. to be held accountable. Corporate bureaucracies are accountable to no one.
41
Next step?
Small claims court?!
Lawsuit?!
Filing with a state regulatory board?
Small claims court?!
Lawsuit?!
Filing with a state regulatory board?
2
Have your doctor fix the billing- tell him he won't get a penny from you if he won't help. Worked for me. Took 18 months.
1
Hospitals contracting physician services to reap the full facility fee and not worry about negotiating physician services with insurers! What! Do you really think hospital CMOS are not aware of the financial advantage. Do you really think insurers are just flummoxed that they have all these doctors in out of network status and suddenly don't have to cover them? Did BCBS help write this?
9
The larger problem here is hospitals and doctors taking advantage of the porous line between patient and provider.
When you patronize a restaurant or fly on an airplane, the company bills you in one single bill, either before or after the service has been provided.
The same practice has to be expected from the hospitals and other health care providers we use.
When I went to the ER for panic related symptoms, all I cared about was being cared for.
At a corporate hospital in California I was billed after the ER visit and the bill, for several thousand dollars, included portions for doctors that had been sub contracted by the hospital.
There was even a separate bill from an outside service provider. At first I did not realize the bill was separate and when I neglected to pay, I received a call from collections.
Another time at a hospital in a Nordic country with a single payer system, I received one bill for less than $100, essentially my copay portion. No outside providers, no confusing billing or insurance to contend with.
Even though the health care system in the US will not look like that of a Nordic country any time soon, we should insist on common practices that are patient friendly and fees and rates that are fair and reasonable.
When you patronize a restaurant or fly on an airplane, the company bills you in one single bill, either before or after the service has been provided.
The same practice has to be expected from the hospitals and other health care providers we use.
When I went to the ER for panic related symptoms, all I cared about was being cared for.
At a corporate hospital in California I was billed after the ER visit and the bill, for several thousand dollars, included portions for doctors that had been sub contracted by the hospital.
There was even a separate bill from an outside service provider. At first I did not realize the bill was separate and when I neglected to pay, I received a call from collections.
Another time at a hospital in a Nordic country with a single payer system, I received one bill for less than $100, essentially my copay portion. No outside providers, no confusing billing or insurance to contend with.
Even though the health care system in the US will not look like that of a Nordic country any time soon, we should insist on common practices that are patient friendly and fees and rates that are fair and reasonable.
32
Here we go again. Corporate takeover of Medicine and privatization of everything with profitability before quality or truth--EMCARE would be the current executive branch's darling.
21
The US has a certain number of people who will devote themselves to ripping off any system out of sheer contempt for systems. They are the bad who drive out the good practically everywhere.
14
SINGLE PAYER!
24
Beyond disgraceful! Very Trump like business practice.
17
Yeah, except unlike Drumpf we have to pay our bills.
2
This is an excellent preview of the Republican proposal for Trump(doesn't)care. Everyone will have "access", but for many health care will be unaffordable and/or the quickest route to bankruptcy while unfettered profiteering thrives. We are the one and only industrialized nation beholden to the expensive fallacy that health care should be a for-profit business rather than a public good. Our health care costs are by far the highest and our outcomes in life expectancy are similar to those of Cuba, which has among the lowest costs. Here's a nice short summary of the accidents that led to our current untenable and unsustainable healthcare system:
http://www.npr.org/templates/story/story.php?storyId=114045132
http://www.npr.org/templates/story/story.php?storyId=114045132
8
The acceleration of regulations favoring big medicine cronies took place under ObamaCare. The law was written by the lobbyists. The only thing the Democrat politicians added was gifts to the balky Democrat Senators who insisted on some extra gravy for their friends.
Health care inflation returned to the pre Bush reform days since the implementation of Obamacare.
This is not a preview of Republican changes. This is a demonstration of how much worse medical cost got under ObamaCare.
Hospital charges increased 33% while the CPI increased 10%. The current screaming about how bad the Republican proposals are is coming from the cronies who fear a pullback of their largesse.
Since the Republicans have not made any changes to ObamaCare, you can thank Obama for the current costs that broke the trend of declining inflation that resulted from the Bush reforms.
Health care inflation returned to the pre Bush reform days since the implementation of Obamacare.
This is not a preview of Republican changes. This is a demonstration of how much worse medical cost got under ObamaCare.
Hospital charges increased 33% while the CPI increased 10%. The current screaming about how bad the Republican proposals are is coming from the cronies who fear a pullback of their largesse.
Since the Republicans have not made any changes to ObamaCare, you can thank Obama for the current costs that broke the trend of declining inflation that resulted from the Bush reforms.
6
Obamacare was Massachusetts-style Romneycare brought to the federal level. It originated in a Heritage Foundation health proposal.
This stuff is Republican in origins and philosophy. It also served Big Pharm and Big Insurance well.
But don't blame rising health care costs on Obamacare -- indeed, we've gotten checks back because certain outfits exceeded their overhead, administrative %!
Blame the health insurance companies and Big Pharm.
Solution? Single payer, prescription drug controls and imports, and a national health service.
This stuff is Republican in origins and philosophy. It also served Big Pharm and Big Insurance well.
But don't blame rising health care costs on Obamacare -- indeed, we've gotten checks back because certain outfits exceeded their overhead, administrative %!
Blame the health insurance companies and Big Pharm.
Solution? Single payer, prescription drug controls and imports, and a national health service.
5
So, let me get this straight. Obamacare was passed so that "Democrat big medicine cronies" got more gravy? And companies like Emcare and the physicians and doctors who contract with them extort patients, because Obama enacted the necessary regulations that "mandate" this extortion through Obamacare. Funny, here I was thinking that a lack of regulations and free market free-for-Alls allow for this racket. Republicans just have a different definition of logic, I guess.
2
This is a form of fraud on the part of both the hospitals and the physician employment agency. The Hospital claims affiliation with an insurance company when it knows full well that it's subcontractors, performing services in behalf of the hospital don't have a such an affiliation. The doctors and their employment agency know full well the reasonable expectation of the patient is that the services provided by the hospital's contractors are covered the same as the hospital. Each knows the truth and knows that the patient is being duped.
It's time for a single payer system.
It's time for a single payer system.
26
It is not fraud, because the government wrote the rules under ObamaCare that allows the behavior. So much for benevolent bureaucrats looking out for the consumer.
The people who have employer provided health insurance, particularly civil servants, have no interest in replacing it with VA waiting lists, the limited networks of Medicaid or the 20% co-pays with no out-of-pocket maximums of Medicare. That is why the Democrats, with 60 Senators, never went anywhere near single payer. they had a six month window, and couldn't get 60 Democrats in the Senate to touch it.
The people who have employer provided health insurance, particularly civil servants, have no interest in replacing it with VA waiting lists, the limited networks of Medicaid or the 20% co-pays with no out-of-pocket maximums of Medicare. That is why the Democrats, with 60 Senators, never went anywhere near single payer. they had a six month window, and couldn't get 60 Democrats in the Senate to touch it.
5
Simply not true that this is an artifact of the ACA. It happened to me in 1999.
9
Single payer does not mean government run hospitals or doctors working for the government. It means one primary insurance company, the US Government. Medicare is single payer for older Americans.
9
This is the reason why most developed countries has opted for different varieties of single payer systems; because of the particular characteristics of the good or service "healthcare". Some countries have laws that prohibit even pharmaceutical companies to advertise their product on national media. Which, makes really good sense to me; because you can't trust human beings for not taking advantage of sick people it's an inherent instinct in them especial when you make healthcare a for profit industry...this fact alone will cause the rule of supply and demand in a markets no to work as they should and will create crazy prices...same as the luxury good market works; therefore, since it affect the well being of the public at large government should to do its job to intervene and regulate heavily...because people lives is at risk from greedy vultures...
11
Almost all countries prohibit prescription drug advertising to the public.
13
OK, question fo NYT: Article IDs one hospital in Crescent City, Calif. What is the point of presenting these findings without an ability to answer "does my hospital use Emcare?"
12
If you go to the Emcare website, or to employment websites such as Glassdoor.com, you will see that Emcare most often operates in small communities such as Bandon in Oregon, Los Alamitos in California, or in hard-pressed inner-city areas. In an echo of the larger debate, those with the least access to health care - through remote locations or downtrodden areas - are the most at risk at running into these operators.
I agree, but go to the "Careers" section of Emcare's website and type in your city and you can see for yourself which hospitals work with them.
The egregious practices of this EMCARE deserve to have the full glare that a free press is best equipped to insure.
I am going to share this NYTimes piece with the many journalists and editors that I correspond with to see that the proper awareness of this predatory company gain the awareness to protect consumers.
I am going to share this NYTimes piece with the many journalists and editors that I correspond with to see that the proper awareness of this predatory company gain the awareness to protect consumers.
13
There may be one way out for those of us who have health insurance and live in areas where there are multiple hospital er alternatives.
Contact each of them now before an emergency, and ascertain whether their er is contracted out, and if it is Em Care, or another private company, which has refused to contract with insurers, plan on going to another hospital.
Further and also, at that time ascertain whether their anesthesiologists and radiologists are contracted out, and if it is EmCare, or another private company which has refused to contract with insurers, boycott them and plan on going to another hospital er.
Unfortunately, where is no choice, and there is not another nearby community with a hospital that will not work. However, if we make it a civic and community issue, just as we are doing at a national level for our health care, just maybe, we can force a change. If our community impacts EmCare profits, where the buck is their almighty, the community may be able to force a change.
Contact each of them now before an emergency, and ascertain whether their er is contracted out, and if it is Em Care, or another private company, which has refused to contract with insurers, plan on going to another hospital.
Further and also, at that time ascertain whether their anesthesiologists and radiologists are contracted out, and if it is EmCare, or another private company which has refused to contract with insurers, boycott them and plan on going to another hospital er.
Unfortunately, where is no choice, and there is not another nearby community with a hospital that will not work. However, if we make it a civic and community issue, just as we are doing at a national level for our health care, just maybe, we can force a change. If our community impacts EmCare profits, where the buck is their almighty, the community may be able to force a change.
15
I'm still angry over a visit to a doc of mine whose practice moved into one of the gargantuan hospital systems in Seattle. I sat in a room with him for an hour discussing the topic for which I had come to see him. This hospital had the gall to charge me a facility fee of $400 just to sit in a room with him. This was in addition to his own fee that was about $450. I expected the specialist's fee but not the facility fee. It took 3 calls to find the right person and was told this was competitive with other hospital systems. This is highway robbery and I'm tired of greedy hospitals and insurance companies destroying healthcare in this country. Don't forget big pharma too. I honestly believe that nothing is going to change until the entire system collapses. Only them will something (hopefully good) rise out of the ashes.
25
Disgrace and your Doctor knew before you came in!
6
The consolidation in the huge hospital systems was a direct consequence of ObamaCare. The growth of those highly profitable systems increased their bargaining leverage with insurers, so the charges your insurance is paying have increased, which is being passed through your insurance.
ObamaCare was designed to make sure that big medicine could extract extra profit, which is why it has to go. The interesting fact is that the big systems are out of network for people who have Medicaid or ObamaCare policies. They have to go to other doctors who are not able to charge as much as the big system hospitals. If a Medicaid or Obamacare patient shows up in need of emergency care at a big medicine hospital, they are obligated to stabilize the patient and then ship him to one of his in-network hospitals. The big boys provide less uncompensated care and responded by raising the charges for the privately insured. That's what happened to the $2500 each family was supposed to save from the "efficiencies" of Obamacare.
ObamaCare was designed to make sure that big medicine could extract extra profit, which is why it has to go. The interesting fact is that the big systems are out of network for people who have Medicaid or ObamaCare policies. They have to go to other doctors who are not able to charge as much as the big system hospitals. If a Medicaid or Obamacare patient shows up in need of emergency care at a big medicine hospital, they are obligated to stabilize the patient and then ship him to one of his in-network hospitals. The big boys provide less uncompensated care and responded by raising the charges for the privately insured. That's what happened to the $2500 each family was supposed to save from the "efficiencies" of Obamacare.
5
Since you're on a dogged mission to blame Obamacare for everything, let me ask you why didn't the Rolls Royce-class hospitals agree to treat HMO clients pre Obamacare, either? Or for that matter, uninsured patients? You deceive readers by claiming hospitals reject Obamacare plans. My ACA plan was the most expensive offered by BCBS, but included treatment in chicago's foremost hospitals and by itheir physicians. It's the "greed" of certain hospitals or doctors to refuse "insufficient" reimbursement rates offered by certain insurers that has existed before Obamacare and will exist under Republicancare. You seem mad that millions more received access to healthcare for the first time in their lives due to the ACA, because you think it drove up your insurance rates.
4
On a recent visit to a local hospital for a fairly routine medical procedure I was required to sign a document informing me that I would be responsible for any Out-of-Network costs. When I asked if any of the people involved in performing the procedure were Out-of-Network providers the 'registration specialist' said he didn't know. When I asked him if he could find out before I signed the consent form he said he had no way of doing that. It's like signing a check with the amount blank and having the person you hand it to say "trust me".
We're now encouraged to be 'informed consumers' where medical matters are concerned today but it is difficult to be an informed consumer when no one can give you any reasonable answers about the cost of care. Legislators could easily remove the mask of mystery from medical costs by passing common sense legislation that would require hospitals and health care providers to clarify the cost of procedures and care so that we can make informed decisions but they choose not to.
We're now encouraged to be 'informed consumers' where medical matters are concerned today but it is difficult to be an informed consumer when no one can give you any reasonable answers about the cost of care. Legislators could easily remove the mask of mystery from medical costs by passing common sense legislation that would require hospitals and health care providers to clarify the cost of procedures and care so that we can make informed decisions but they choose not to.
35
You know what the cure for this is........Single Payer Healthcare.
24
Ha ha. The single payer would still have to pay whatever the hospital billed. Nothing about single payer reduces costs. Medicare overpays 30%.
4
Untrue. Look up DRG.
1
Capitalism is not a viable solution to health care. It may have been once upon a time when doctors and hospitals had a standard of morality you could rely upon. Now it is too often just a tilted playing field of potential crooks making another quick hit.
Morals work to mitigate most injustice, but when there is this rising tide of immorality the only solution is regulation. It is a poor solution, but a necessary one. However, regulation is not being readied because there are industries that prefer injustice when it makes them money.
The medical-pharmacy-insurance industry needs the same regulation that was used to bust the trusts, and monopolies in an earlier age. Real competition may work better than government control - but get us real competition before you consider a comparison.
Doctors all over the world get their degrees cheap and quick then migrate to USA so as to ride the gravy train.
Morals work to mitigate most injustice, but when there is this rising tide of immorality the only solution is regulation. It is a poor solution, but a necessary one. However, regulation is not being readied because there are industries that prefer injustice when it makes them money.
The medical-pharmacy-insurance industry needs the same regulation that was used to bust the trusts, and monopolies in an earlier age. Real competition may work better than government control - but get us real competition before you consider a comparison.
Doctors all over the world get their degrees cheap and quick then migrate to USA so as to ride the gravy train.
7
Excellent. But start with medical school - or higher education in general. And look at those countries that feel it is important to educate their medical professionals on public money rather than have them start with gigantic debts into their careers. In fact, might the poor be as snobbish about elite education if it was similarly funded (public) as our war machines? Nobody thinks soldiers should have to pay for their training, right. In fact we give them extra money to take up more education afterwards.
12
The scam continues.....
7
I would greatly appreciate a list of hospitals who contract with Em Care. Because I cannot afford to be treated at those hospitals.
23
Yes, I wanted to know that too. So I went to EmCare.com/the-envision-difference/locations, "Search for Clinical Jobs" and was horrified to find that there were jobs advertised in our Toms River hospital, Brick and Point Pleasant hospitals too! Lakewood hospital wasn't listed in their employment opportunities. Scary.......
1
I Went to er 9:30 P.M. you get less qualified D.R. on late shift. They billed me for MD she was a DO. My wife went to er 3AM first Doctor. Was Falling asleep in the chair next to my wife barley keep his eyes open. 3 hours later shift change new doctor took care of her. If u can hold off till day shift u will get better care. Pricy but better care. 2 different visits same er.
2
BTW a D.O. is a fully licensed physician.
13
Your comment describing Osteopathic Doctors as somehow less qualified to treat patients has no basis in fact.
Osteopathic Physicians (D.O.) are no less well qualified than Allopathic (M.D.) Physicians. Under an agreement made decades ago, Doctors graduating from Osteopathic Medical Schools are eligible to do residencies in the same programs and hospitals as graduates of Allopathic Medical Schools.
As far as qualifications go, the majority of Doctors working in Emergency Rooms are not board certified in Emergency Medicine. They are commonly from a variety of Residencies, but Family Medicine and Internal Medicine seem most common.
As to your complaint about a Doctor falling asleep in the chair, 12 hour shifts for Doctors working in Emergency Rooms is quite common and working 24 hours is not uncommon in rural hospital ERs. It is also not unusual to see a Family Physician working overnight in an ER after working in their clinic that day. The massive debt so many young Doctors are under in the US probably causes a large amount of this. Many young Physicians find themselves $300,000 or more in debt by the time they finish their Residency training.
America desperately needs to re-think the way we treat patients, the way we train Doctors, they way we insure people, the way we pay for Medicine and how we finance it all. Despite this, there are so many well financed interests determined to protect their turf and maintain the status quo it is not very likely.
Osteopathic Physicians (D.O.) are no less well qualified than Allopathic (M.D.) Physicians. Under an agreement made decades ago, Doctors graduating from Osteopathic Medical Schools are eligible to do residencies in the same programs and hospitals as graduates of Allopathic Medical Schools.
As far as qualifications go, the majority of Doctors working in Emergency Rooms are not board certified in Emergency Medicine. They are commonly from a variety of Residencies, but Family Medicine and Internal Medicine seem most common.
As to your complaint about a Doctor falling asleep in the chair, 12 hour shifts for Doctors working in Emergency Rooms is quite common and working 24 hours is not uncommon in rural hospital ERs. It is also not unusual to see a Family Physician working overnight in an ER after working in their clinic that day. The massive debt so many young Doctors are under in the US probably causes a large amount of this. Many young Physicians find themselves $300,000 or more in debt by the time they finish their Residency training.
America desperately needs to re-think the way we treat patients, the way we train Doctors, they way we insure people, the way we pay for Medicine and how we finance it all. Despite this, there are so many well financed interests determined to protect their turf and maintain the status quo it is not very likely.
19
The solution is outcome-based billing, instead of pay-per-minute or pay-per-procedure. If a doctor sets a broken ankle, there is one set fee for that. Complications can add to the fee, but not the in/out-of-network status of the doctor.
3
Paragraph one explains it all.
"The hospital had been struggling to find doctors to work in its E.R."
EmCare had to pay doctors more to work in that E.R. and that's why it's costs are higher.
There is nothing nefarious other than simple supply and demand.
In this case the supply was scarce so the cost is higher.
"The hospital had been struggling to find doctors to work in its E.R."
EmCare had to pay doctors more to work in that E.R. and that's why it's costs are higher.
There is nothing nefarious other than simple supply and demand.
In this case the supply was scarce so the cost is higher.
3
No, not if the price charged at the same hospitsl for the same service differs if you see Hospital doc vs EmCare doc. It has to do with negotiated prices with insurers, which make "shopping around" the farce it truely is. You have no control over which doctor sees you. And to expect a person having a heart attack to stop and ask the doctor coming into examine him "are you in or out of my insurance network" is ludicrous. To balance the staffing problems, which if you had a single payor, with all doctors getting the same reimbursement for the same service, could be handled as some progrms do now, by helping doctors pay off the loans for their education for service in high need areas.
12
I am a fairly conservative guy, but it is painfully obvious that we need a single -payer system.
31
As long as for-profit corporations have the ears, and stuff the wallets, of our legislators at all levels we will never have a health care system that benefits us financially, that is, surprise billing, balance billing and egregious co-pays, deductibles and premiums.
Em-Care is only one spoke in the wheel that insures (no pun intended) that we will never see universal or single payer care. The stakes are too high for the politicians...
Em-Care is only one spoke in the wheel that insures (no pun intended) that we will never see universal or single payer care. The stakes are too high for the politicians...
15
Do you have some basis for assuming that the hospital under review id not a charity, not-for-profit entity? Most of the most profitable hospital systems are theoretically charities, but you can't tell from the salaries their non physician executives are paid.
1
Everyone besides EmCare can probably agree this is outrageous. There oughta be a law! Why isn't there one? Why this ridiculous patchwork system?
9
The system exists as it does because that is the way ObamaCare wanted it to be. They enlisted support from the AMA, drug companies, insurers, charity and for-profit hospitals that guaranteed them more paying customers who would pay bigger bills. That's why big medicine financed the publicity campaign. That is also why cronies like The Kaiser family Foundation are conducting surveys and publishing their "analysis" to pretend that people will suffer if ObamaCare is modified to remove largess from their for-profit sister organizations like Kaiser Permanante.
The law allows and encourages the big medicine cronies to maximize their profits at the expense of the peasants who think the law was written to give them health care. The law was written to give them health INSURANCE so that big medicine would get paid. The balance billing on out-of-network care is gravy to the people who "helped" Sebilius write the regulations.
Had the federal government had an interest in providing affordable care, they would have written laws to provide transparency about cost and quality of care.
The law allows and encourages the big medicine cronies to maximize their profits at the expense of the peasants who think the law was written to give them health care. The law was written to give them health INSURANCE so that big medicine would get paid. The balance billing on out-of-network care is gravy to the people who "helped" Sebilius write the regulations.
Had the federal government had an interest in providing affordable care, they would have written laws to provide transparency about cost and quality of care.
1
Like so many commenters, EmCare makes the open and shut case for Single Payer. Let's let republicans make EmCare their personal ER provider.
That was easy, wasn't it?
That was easy, wasn't it?
27
Since EmCare is a creation of ObamaCare, wouldn't it be fairer to make it the personal ER provider for Democrats.
Funny how ObamaCare made everything worse, but you blame Republicans who have not been able to figure out how to undo the damage done by the Democrats.
Funny how ObamaCare made everything worse, but you blame Republicans who have not been able to figure out how to undo the damage done by the Democrats.
EmCare has been around since 1972, doing pretty much the same thing. It isn't a creature of Obamacare even if that doesn't fit your agenda. Playing party politics with healthcare is not helpful.
2
I thought doctors were supposed to want to help people. What kind of scoundrels work for a place like EmCare? This is what happen when we privatize healthcare.
12
The doctors don't have much choice. Do you leave the hospital you love because of a change in the management group? How does that help your patients?
Unfortunately, lots of hospitals bought up doctor's groups, then outsourced them to for- profit companies like Emcare. Depending on where you work, the Hospitalist's, er docs and trauma services could be outsourced to Emcare.
There is plenty of bad management in health care, where the managers don't have the same goals as the doctors. Emcare is one amongst many. There may not be many other choices for a physician in a particular community.
This is where good government might help by regulating certain behaviors but that's not going to happen any time soon.
Unfortunately, lots of hospitals bought up doctor's groups, then outsourced them to for- profit companies like Emcare. Depending on where you work, the Hospitalist's, er docs and trauma services could be outsourced to Emcare.
There is plenty of bad management in health care, where the managers don't have the same goals as the doctors. Emcare is one amongst many. There may not be many other choices for a physician in a particular community.
This is where good government might help by regulating certain behaviors but that's not going to happen any time soon.
11
Unfortunately when staffing companies provide a large portion of the employment in your specialty in your geographic area you might need to take a job with them to stay employed at all.
1
The brutal world of trump and the republicans. This did not happen when President Obama was in office.
2
You might want to re-read the article, which clearly states that early last year [that would be 2016, while Obama was President] EmCare took over the ER management of the hospital. This year, after Trump took office, they discontinued the contract.
It happened under Obama as a result of the regulations put in place by HHS under the direction of Obama. None of this is the responsibility of any Republicans.
Take a deep breath and consider the possibility that when Republicans opposed ObamaCare while it was being written that it was because they were smart enough to see it would raise costs and not provide any benefit. Their prediction was correct. Their challenge now is to figure out how to undo the damage that was done by the Democrats to so many people who are paying more for less.
It happened under Obama as a result of the regulations put in place by HHS under the direction of Obama. None of this is the responsibility of any Republicans.
Take a deep breath and consider the possibility that when Republicans opposed ObamaCare while it was being written that it was because they were smart enough to see it would raise costs and not provide any benefit. Their prediction was correct. Their challenge now is to figure out how to undo the damage that was done by the Democrats to so many people who are paying more for less.
3
Please read the article. The study data was from 2011 to 2015. I am no fan of the Trump/Republican health plan, but it had nothing to do with with this travesty.
The reflexive finger pointing of some commenters is dismaying.
The reflexive finger pointing of some commenters is dismaying.
The idea that you have no idea what you are purchasing is flawed. The notion that you are in any shape to understand or deal with that while suffering a health crisis is ridiculous, and predatory.
When was the last time that you agreed to get a bill from any service provider that had one line item and no explanation of billing, procedure or itemized expenses? Never - that's when.
And yet, I just got a bill for outpatient surgery where I know that they performed a procedure that they knew wouldn't work. I checked with my normal surgeon. The bill? One line item: medical services @ $64,578. The good news? The insurance company's contracted price with this facility was only $45,000. This included a $17,000 charge for the aforementioned unnecessary procedure.
Moreover, if $65,000 is the cost of service, and insurance is paying $45,000, what happened to the other $20k? They don't operate at that kind of a loss, so it's all fluff designed to beef up your bill so you pay more personally out of pocket with deductibles and reach your max payout quicker.
These 'companies' (hospitals) are churning your accounts and hiding behind one-line billing statements with ZERO transparency. Their outsourced doctors and departments are sales tools to stay in a troubled business. The irony is that none of these people can manage to make a reasonable profit without grossly exploiting the system. Or is that true?
Why do your congressmen not care about billing transparency?
When was the last time that you agreed to get a bill from any service provider that had one line item and no explanation of billing, procedure or itemized expenses? Never - that's when.
And yet, I just got a bill for outpatient surgery where I know that they performed a procedure that they knew wouldn't work. I checked with my normal surgeon. The bill? One line item: medical services @ $64,578. The good news? The insurance company's contracted price with this facility was only $45,000. This included a $17,000 charge for the aforementioned unnecessary procedure.
Moreover, if $65,000 is the cost of service, and insurance is paying $45,000, what happened to the other $20k? They don't operate at that kind of a loss, so it's all fluff designed to beef up your bill so you pay more personally out of pocket with deductibles and reach your max payout quicker.
These 'companies' (hospitals) are churning your accounts and hiding behind one-line billing statements with ZERO transparency. Their outsourced doctors and departments are sales tools to stay in a troubled business. The irony is that none of these people can manage to make a reasonable profit without grossly exploiting the system. Or is that true?
Why do your congressmen not care about billing transparency?
21
Republicans are anemic to transparency in any form. A party and political grip in the grip of almost all major sins, greed, lying, brutality. You name it.
2
The Republicans have not made any changes to ObamaCare, so how does any of this have to do with Republicans. [They also did not have anything to do with writing or passing the law.]
This is all about how much damage the Democrats did to the system.
If the Democrats had wanted to improve medical service, they would have implemented regulations that would have provided transparency with respect to cost and quality. They didn't because the big medicine cronies capitalize on secrecy to maximize profits. ObamaCare was designed to be a gift to big medicine, and is functioning as intended, with the taxpayer and consumer of medical services paying the bill.
This is all about how much damage the Democrats did to the system.
If the Democrats had wanted to improve medical service, they would have implemented regulations that would have provided transparency with respect to cost and quality. They didn't because the big medicine cronies capitalize on secrecy to maximize profits. ObamaCare was designed to be a gift to big medicine, and is functioning as intended, with the taxpayer and consumer of medical services paying the bill.
2
Medicare and Medicaid bill at a discount to list prices. The anonymous bureaucrats who set the prices for hospital services use the list prices to determine the controlled price they will pay for procedures. The insurers negotiate their payments as a premium over the Medicare prices [there are tens of thousands of codes, each with a regional price.] The hospitals increase their revenue for Medicare as well as for private insurers by selecting codes that imply a higher level of service or a more complicated procedure. It is a massive game.
The list prices are like suggested manufacturer's prices. Go to Amazon's web site and them convince yourself that you are getting a bargain when you buy a widget that "should" cost $49.95 for $19.95, a 60% saving.
Your insurance still paid $17,000 for the unnecessary procedure. Now try to convince yourself that it cost anywhere near even the discounted $17,000 to provide the service. As you are reviewing you bill, also convince yourself that the box of generic tissues cost them $5, that the Tylenol cost $20, that the plastic pitcher and cup cost $20.
They billed your insurance some thousands of dollars for your use of the facility, which did not include a $0.10 Tylenol or even a cup of tap water with which to swallow it.
The list prices are like suggested manufacturer's prices. Go to Amazon's web site and them convince yourself that you are getting a bargain when you buy a widget that "should" cost $49.95 for $19.95, a 60% saving.
Your insurance still paid $17,000 for the unnecessary procedure. Now try to convince yourself that it cost anywhere near even the discounted $17,000 to provide the service. As you are reviewing you bill, also convince yourself that the box of generic tissues cost them $5, that the Tylenol cost $20, that the plastic pitcher and cup cost $20.
They billed your insurance some thousands of dollars for your use of the facility, which did not include a $0.10 Tylenol or even a cup of tap water with which to swallow it.
1
So here it is, as if we were not already abused to the nth degree, by our corporate owned government, here is the latest revelation of the rampant corruption and theft that is occurring throughout the United States of America, at the avaricious hands of Big Businesses, including doctors, hospitals, medical insurance companies, pharmaceutical companies, and the myriad other entities which collude with these charlatans, bamboozling the poor and the middle-class, bankrupting many, and driving the rest into economic slavery and penury.
There is no doubt whatsoever, in my mind, and in the mind of tens of millions of long suffering Americans, that this escalating abuse will be stopped, and "we the dangerously angry people", will stop it, first in every minor local election, every state election, every midterm, and every 4 year Presidential term, by completely ignoring every Republican and Democratic politician, and instead searching out and placing in office true representatives of the people, philosophically similar to Bernie Sanders.
It will take another decade or so to accomplish this, nevertheless we will right this ship of ours, and watch with great relish as our corrupt masters are exiled to the wilderness, never to return.
There is no doubt whatsoever, in my mind, and in the mind of tens of millions of long suffering Americans, that this escalating abuse will be stopped, and "we the dangerously angry people", will stop it, first in every minor local election, every state election, every midterm, and every 4 year Presidential term, by completely ignoring every Republican and Democratic politician, and instead searching out and placing in office true representatives of the people, philosophically similar to Bernie Sanders.
It will take another decade or so to accomplish this, nevertheless we will right this ship of ours, and watch with great relish as our corrupt masters are exiled to the wilderness, never to return.
9
Greed is good in America. That should be placed on the $100 bill. My insurance company once got a $10,000 bill for something I never received. They would have paid if I had not contacted them. The hospital claimed "billing error".
I's sure this happens every day hundreds if not thousands of times.
I's sure this happens every day hundreds if not thousands of times.
4
Medicare was billed for three cataract surgeries for my mother within a four week period. She had to call the physician and Medicare and never received a corrected explanation of benefits, so there is no way to tell whether the third surgery was paid or not. Medicare was also billed for a specialist visit as well as a procedure. The doctor never touched her during the office visit. She refused to pay the co-pay and notified Medicare. They said they'd already paid the bill so tough luck. The doctor waived the second co-pay, satisfied with the Medicare payment for the service not performed.
2
I love the part about Emcare buying up groups of anesthesiologists and radiologists who are often out of network. Think of the dynamics. You have an emergency and go to the ER, possibly in an ambulance or incapacitated in some way. The ER must treat you by law. You go in for surgery and have no idea who reviewed the imaging or who the anesthesiologist is but neither is in the hospitals network contract and the fact is they can bill whatever they want. This kind of thing happens all the time. How is this any different than tripling the charge for an epipen simply because you can.
16
The $100 EpiPen inflating to $600, as well as the balance billing on the out-of-network anesthesiologist and radiologist and ER physician are all allowable under the regulations of ObamaCare. Democrats had no intention of addressing the abuses in the system. Their priority was making the Little Sisters pay for contraceptives. If they'd have accomplished that objective, nothing would be able to prevent them from forcing the nuns to pay for abortions. Which is why they fought so hard.
Perhaps if the Democrats hadn't been so intent on pursuing their partisan objectives, they could have made some improvements to the system that would have benefited consumers. But that was never on their list of things to do.
Perhaps if the Democrats hadn't been so intent on pursuing their partisan objectives, they could have made some improvements to the system that would have benefited consumers. But that was never on their list of things to do.
1
In British Columbia most doctors are paid fee for service negotiated with the govt. Some may be on salary and some are capitation which is how general practicioners are paid in the UK. Ontario has very much adopted capitation...person signs on with a family doc but must stay with that group of providers. In BC doctors earnings are published. For years the govt.has done random and targeted audits for outliers. Recently a urologist in Burnaby BC, a Vancouver suburb, was criminally charged and convicted for fraudulent billing. Do not worry..he is NOT going to jail.
3
There are greedy doctors like any other profession. The answer is to get rid of them. Let them join some concierge firm that caters to the wealthy. It's where all unethical professionals belong.
3
The whole medical industry is broken. Instead of fighting back and forth adding to the chaos congress should get a hold on it. Yes I'm going to say that dirty word "regulations " it's either that or we all go back to self healing grandmas ' remedies. It's like the Wild Wild West. Who benefits? Not America, not its people.
3
These people should go to jail and their customers should be reimbursed. Medicare for all. Put these profiteers out of business.
8
Choose a hospital? What kind of universe does this reporter live in. You go where the guys driving the ambulance--sometimes volunteer firefighters--take you, usually the closest hospital, and many people are not in a position to reject a physician in the ER because of "network" status.
Really, to continue the whole health care discussion on the assumption there is choice is irresponsible at best. When the next hospital is an hour away, there is no "choice". And ditto for specialists. Consumer choice has no place in the health care discussion.
Really, to continue the whole health care discussion on the assumption there is choice is irresponsible at best. When the next hospital is an hour away, there is no "choice". And ditto for specialists. Consumer choice has no place in the health care discussion.
9
The ambulance service had already negotiated a contract on which hospital they 'need to go to' due to their contract. Not negotiable at all- this starts the patient on ' being taken for a ride'....
4
Single Payer would solve all of this! It's a shame our nation's two top Democrats: Pelosi and Schumer- will not openly endorse this common sense solution to healthcare.. What are they afraid of .. helping people?
4
They know which side of their bread is buttered. The big medicine cronies provide campaign contributions that get them re-elected as well as jobs for their friends and family, private jets to take them on fact finding trips and other largesse. Pelosi and Schumer have no interest in helping people. People don't pay them enough.
Why don't we call it what is really is: these people who run this so-called network are crooks and fraudsters, who need to be prosecuted, fined and jailed for their efforts. This is why regulation of these companies is important, not the irrelevant arguments that the market will weed out these overchargers. Perhaps the markets will stabilize over many years or decades, but most of us can't wait that long when the collection agency is on your doorstep. The woman mentioned in the article who tihnks she must pay the $500 billed by out-of-network needs to complain and refuse to pay OON charges. I always fight paying that kind of billing, and ALWAYS win, with healthcare companies very eager to reduce the charges to in-network rates or even cancel the entire bill, without fanfare. They don't want to singled out for poor ethics.
3
I was in an untenable situation in an ER not of my making or permission which ended up with a $1K bill from a 70s-educated doctor on the make. I believe two sentences were exchanged between us, one being my lack of consent for treatment I didn't require. I learned the coding on the bill was something false and astonishing that did not exist.
It took me two years and long phone calls every six weeks or so to his billing group in Philadelphia before a breakthrough occurred. During that time carrying the monkey bill on my back the original $1K bill kept going down to about half. No dice.
Finally, I realized the magic term was: "I'll bring in the CONSUMER FINANCIAL PROTECTION BUREAU to deal with your erroneous bill.
This got their attention and a couple of phone calls later, I was promised and then received, a letter stating I did not owe a dime. I nearly cried in gratitude on the phone. I remember it clearly because it was Martin Luther King Day and I spoke at length about justice to the billing supervisor.
It took me two years and long phone calls every six weeks or so to his billing group in Philadelphia before a breakthrough occurred. During that time carrying the monkey bill on my back the original $1K bill kept going down to about half. No dice.
Finally, I realized the magic term was: "I'll bring in the CONSUMER FINANCIAL PROTECTION BUREAU to deal with your erroneous bill.
This got their attention and a couple of phone calls later, I was promised and then received, a letter stating I did not owe a dime. I nearly cried in gratitude on the phone. I remember it clearly because it was Martin Luther King Day and I spoke at length about justice to the billing supervisor.
8
The actual vulnerability for these up coding scoundrels is quite simple.
In order to support a higher level of charge than the actual visit would support the groups hired gun docs need to make the chart reflect that higher level of service.
They commonly use templates or fabrications (lies) that reflect exams not actually performed by the physician on the patient and lines of questioning not actually entertained.
It is fraud and if you do it on Medicare patients it is called Medicare fraud.
Patients who feel ripped off or hospitals who smell rats in the ER only need to pull charts and interview patients independently on what was done or said.
Accuse individual physicians of fraud and EmCare plays nice.
In order to support a higher level of charge than the actual visit would support the groups hired gun docs need to make the chart reflect that higher level of service.
They commonly use templates or fabrications (lies) that reflect exams not actually performed by the physician on the patient and lines of questioning not actually entertained.
It is fraud and if you do it on Medicare patients it is called Medicare fraud.
Patients who feel ripped off or hospitals who smell rats in the ER only need to pull charts and interview patients independently on what was done or said.
Accuse individual physicians of fraud and EmCare plays nice.
5
What makes you believe that the doctors do not put the not provided services on the chart. Where do you believe the billing clerk gets the information? The doctors are well trained to document their bills.
Things will only get worse in the US. American who can think out of the box need to emigrate to other countries.
1
So not only is it hard and expensive to obtain insurance (perhaps soon impossible for many if Republicans have their way), it doesn't even cover you when you need it?
3
Insurance is intended by the Democrats to make sure that big medicine gets paid. The insurance does pay for the out-of-network providers, but since they have no obligation to accept a price they didn't negotiate, they bill the difference to the patient. That is the way the Democrats wanted the regulations to work, so their cronies could get even more money.
Once again, and more proof that single payer is THE ONLY ANSWER.
HEALTH IS NOT A FREE MARKET BUSINESS....HEALTH CARE IS A HUMAN RIGHT.
I am disgusted by American view of health care.
As Americans, we are an embarrassment in the eyes of the world.
HEALTH IS NOT A FREE MARKET BUSINESS....HEALTH CARE IS A HUMAN RIGHT.
I am disgusted by American view of health care.
As Americans, we are an embarrassment in the eyes of the world.
5
Medicare is single payer. Providers up code their billing to increase their profits. Single payer does not resolve the problem of hospitals charging higher rates than the services they provide. The problem is even worse with Medicare, because Medicare pays all bills they receive.
With out-of-network balance billing, at least the affected consumer has the motivation to fight the charges. The $10/hour contractor paying the bill has no incentive to question a bill and no expertise to evaluate it or even know if the procedure was performed or necessary. Medicare admits that 30% of the payments they make are for unnecessary, duplicative, or for services not rendered.
With out-of-network balance billing, at least the affected consumer has the motivation to fight the charges. The $10/hour contractor paying the bill has no incentive to question a bill and no expertise to evaluate it or even know if the procedure was performed or necessary. Medicare admits that 30% of the payments they make are for unnecessary, duplicative, or for services not rendered.
Who hired you to respond to every comment??
1
No Medicare is not single payer. Medicare only pays
80% plus a year deductible. Therefore insurance companies their grubby fingers on health care pie.
Single payer would totally eliminate the need for EmCare insurance industry, billing/coding, ever expanding administration costs (28%-/+ of any hospital charge).
Single payer would be paid for out of:
A) simple tax which would far less per person than so called health insurance/Affordable Care Act.
B) reduction in military spending (good for us and good for the rest of the world).
For those who don't think this is possible to have single payer look to the rest of the first world.
More than 70% of Americans want a single payer system. So why don't we have it!
Incompetence or corruption?
80% plus a year deductible. Therefore insurance companies their grubby fingers on health care pie.
Single payer would totally eliminate the need for EmCare insurance industry, billing/coding, ever expanding administration costs (28%-/+ of any hospital charge).
Single payer would be paid for out of:
A) simple tax which would far less per person than so called health insurance/Affordable Care Act.
B) reduction in military spending (good for us and good for the rest of the world).
For those who don't think this is possible to have single payer look to the rest of the first world.
More than 70% of Americans want a single payer system. So why don't we have it!
Incompetence or corruption?
The real problem with health care.
All these side deals that the consumer has no control over.
There should be no out of network. It's a scam made up by hospitals and insurance companies.
Coding is another scam. If you can get the right person to submit your bill you, will make out, if not you will pay a higher price.
These are the things that should be fixed, and only then will health insurance rates come down.
Regulation is not a dirty word!
All these side deals that the consumer has no control over.
There should be no out of network. It's a scam made up by hospitals and insurance companies.
Coding is another scam. If you can get the right person to submit your bill you, will make out, if not you will pay a higher price.
These are the things that should be fixed, and only then will health insurance rates come down.
Regulation is not a dirty word!
3
There's a simple phrase for what EmCare is doing: price gouging.
In nation that prizes people over profits, this company would be severely punished by the courts and by regulators.
We don't live in such a nation.
In nation that prizes people over profits, this company would be severely punished by the courts and by regulators.
We don't live in such a nation.
2
@ NYT - Your Y-axes on the 8 graphs have a single number. They are uninterpretable without at least a second number. Did Hospital A jump to 100% from 10%, or from 99%?
3
The entire network system is a disgrace that benefits no one.
It's amazing how many Americans don't realize that other people don't have to put up with this.
1
When I tried to find out WHO and WHAT I was being charged for, the EM and hospital refused to tell me - they said they couldn't because of HIPAA regulations. I eventually gave up
3
It doesn't matter which healthcare plan the government implements if prices can't be regulated.
1
The health care monopoly needs to be broken up. What other industry in the US can thumb its nose at providing any customer service? Even Comcast is trying to reform itself.
2
I've been questioning how an anesthesiologist I know of was making 2 million a year. Great at his job I'm sure, but nevertheless it always sounded fishy to me that his pay was so high. It may or may not be related to this Emcare situation, could be yet another out of control cost issue.
1
in other words CROOKS
1
How is this anything other than gouging? As a medical practitioner I find this sort of thing to be despicable. Billing a patient hundreds of dollars for a cursory thirty-second glance at their ankle is simply Trump levels of shysterism. These bottom-feeding opportunists should be drummed out of our profession. We all need to eat, but that's just sleazy exploitation.
7
This has nothing to do with Trump. It's been going on for years. That neither increases nor decreases that it is despicable. It simply illustrates that cheap political shots serve only to confuse, not edify.
1
Will the authors please stop calling patients "customers". I very quickly became confused by the article as to who's billing and ripping off whom until (I think!) I finally figured out that "customers" are really patients.
Contracting hospitals are customers (of EmCare). Patients are patients.
Or is this another right-wing trick to try to think of we patients as "consumers"?
At any rate it shows once again why we need a single-payer, Original Medicare-like health care system. And to get rid of those bloated-salaried insurance company CEO's.
Contracting hospitals are customers (of EmCare). Patients are patients.
Or is this another right-wing trick to try to think of we patients as "consumers"?
At any rate it shows once again why we need a single-payer, Original Medicare-like health care system. And to get rid of those bloated-salaried insurance company CEO's.
7
This whole situation should be made ILLEGAL.
The way I see it, I should not have to pay anything because:
(1) It is outright FRAUD.
(2) It is FALSE ADVERTISING.
If $350K/yr is not enough for you, too bad. Learn to live with it.
The way I see it, I should not have to pay anything because:
(1) It is outright FRAUD.
(2) It is FALSE ADVERTISING.
If $350K/yr is not enough for you, too bad. Learn to live with it.
3
I would love to find the clown that determines what deemed a " reasonable and customary charge" and put the individual in a room with a patient who just received the bill. As to EmCare, the hospitals before engaging their service, should have ensured they had negotiated rates with the major insurers in the area.
JUST DON'T PAY more than you should--old fee, etc.
Crooks. You never agreed to unreasonable charges--just the normal, usual, reasonable.
Let them go whistle--CROOKS!!!!
(It does work. I've done it.)
Crooks. You never agreed to unreasonable charges--just the normal, usual, reasonable.
Let them go whistle--CROOKS!!!!
(It does work. I've done it.)
In a similar vein....several years ago I was hospitalized for a serious infection following surgery. Was in hospital for a week. Everyday they drew blood and sent it down to the pathology lab for analysis. I had great insurance, but when I got the explanation of benefits, I was being charged for all the lab work. I called my insur company immediately and they ended up paying. Apparently the hospital,which was in my plan, had "out sourced" some of the pathology/lab work to a group that was not in the plan. How was I supposed to know that? Was I supposed to ask lying there sick in bed...."hey, who's gonna be checking my blood samples?" I was fortunate the insurance co. understood my side and paid the "outside" pathology group. Was weird, tho.
5
Single payer, single payer will stop this medical gouging. Greed is so ugly, especially for the ill who can't fight back. Single payer!
3
This is exactly how not to practice Emergency Medicine...this is one area where good clinical exam and truly listening to patient complaint can provide exemplary medical care delivered efficiently with compassion and kindness. Yet another argument for ONE payer system. This is the rape of the specialty of Emergency Medicine...and ultimately a debasing of sacred trust between a patient and their physicians. ACEP needs to fight this cancer head on.
4
It's highway robbery. And there seem to be no shortage of participants. "Nearly a quarter of all emergency room doctors now work for a national staffing firm, according to a 2013 Deutsche Bank report." How many of these doctors are affiliated with EmCare?
A friend of mine was taken to a hospital emergency room when he experienced some chest discomfort. A healthy middle-aged man, he was kept there for observation overnight. He went home on his own less than twenty-four hours later. His bill was over ten thousand dollars---about five hundred dollars for each hour he stayed in that room.
A friend of mine was taken to a hospital emergency room when he experienced some chest discomfort. A healthy middle-aged man, he was kept there for observation overnight. He went home on his own less than twenty-four hours later. His bill was over ten thousand dollars---about five hundred dollars for each hour he stayed in that room.
3
I got my first taste of this at Cleveland Clinic's community hospitals' ERs. No one tells you the doctor is not a Celevrlsnd Clinic employee and why would you think otherwise. Until you get whopper bills for next to no cate. Or excessive care. Try calling? No response. Ditto on emailing and letters. Refuse to pay and the creditors are barking at you. Hospitals who go in this direction without full transparency are morally bankrupt
7
Simple solution. If you have to go to an ER do not give any personal info. John orJane Doe with a general delivery address works. Get stabilized and then go see your Doctor. Hospitals are criminals not deserving of one dime.
5
I'm am an ER doc. EMCARE is evil and has no soul. It represent everything that is wrong with healthcare in America. Want a free market solution? Enjoy your EMCARE bill! It's only going to get worse.
12
It would be really great reporting if the hospitals were identified so we could possibly avoid those thieves
2
"she was shocked to get an additional bill from a doctor who she said never identified himself and only briefly touched her broken ankle. That physician worked for EmCare. "
What I do not understand is why this sort of quickie medical "gesture" is even legally billable. What exactly was the specific medical service provided such that the patient benefitted? In court, how would Dr. "EmCare" defend himself as justified in getting payment for doing nothing of substance?
What I do not understand is why this sort of quickie medical "gesture" is even legally billable. What exactly was the specific medical service provided such that the patient benefitted? In court, how would Dr. "EmCare" defend himself as justified in getting payment for doing nothing of substance?
3
Is EmCare publicly traded? If so, there is a strong possibility that many Republican representatives and senators have purchased stock in this company or may be in the process of buying EmCare stock.
3
Tom Price probably owns EmCare.
The solution is to apply "Trumpcare" or "Pricecare" (named after the HHS leader) and then have the BEST health care at a very low price. Or just never get sick or vist an ER.
As long as Greed is the driving force for Emcare, along with some physicians willing to go along, patients will be left with an unjustifiably monstrous bill. This is not right, is unjust, and plain stupid. A for-profit enterprise providing health care is incompatible with decency and compassion, and it's efficiency is one-sided, to fill their pockets. Why is it that patients are always the ones holding the bag?
2
In the 1950s, the local physician was the wealthiest person in the neighborhood. No longer. Now he lives in the rich person's neighborhood and complains how insurance payments are stifling his income: MD should not mean More Dinero.
3
The usual, such as private prisons run scandalously, EmCare is another crooked operation, no pun intended.
2
EmCare has been around for a while and has a well known reputation. The hospital administrators that bring them in already know what will happen.
Continuing to wrongly blame doctors for this sort of phenomenon won't help the situation; doctors sold out decades ago and no longer have the power to pull off this sort of collusion.
Continuing to wrongly blame doctors for this sort of phenomenon won't help the situation; doctors sold out decades ago and no longer have the power to pull off this sort of collusion.
To figure out (and avoid) an EmCare hospital, look for the job listings for EmCare in your area.
4
Profit has no business in health care.
4
Capitalism without regulation in the healthcare field is a sin and constitutes theft in cases like EMCARE.
Clearly, the hospitals did not do any due diligence on this company. They deserve as much of the responsibility as EMCARE.
Clearly, the hospitals did not do any due diligence on this company. They deserve as much of the responsibility as EMCARE.
1
Down in Boerne Texas the Methodist ER gave their ER over to a company that only hires doctors that don't take insurance, not even Medicare.
I did the math on the one in Boerne the night I took my wife there:
*asked the folks how many people they expected in that night...at about 10 PM they were approaching 100...so let's say 150 people all night
*Our insurance paid about $150 then the company the doctor "worked for" charged over $500...since they probably did this to everyone even figuring only $500 each that's (500X150) $75,000 for a 24 hour shift or over $3000 per hour..not bad for a part time job. If these doctors do two 24 hour shifts per month that's (2x12x75) $1.8 million a year scammed from people that came for help-in their weakest moments-afraid they might die-unable to negotiate and not knowing the situation. When I threw this calculation in their face they dropped the charges to keep me quiet I guess. ER doctors are only there to serve themselves. By the way...the doctor spent about 10 minutes with my wife TOTAL...the rest of the time we were there was waiting for her primary care doctor to authorize her release. This stuff is condoned by the Texas legislature and apparently by legislatures country wide...SHAME!
I did the math on the one in Boerne the night I took my wife there:
*asked the folks how many people they expected in that night...at about 10 PM they were approaching 100...so let's say 150 people all night
*Our insurance paid about $150 then the company the doctor "worked for" charged over $500...since they probably did this to everyone even figuring only $500 each that's (500X150) $75,000 for a 24 hour shift or over $3000 per hour..not bad for a part time job. If these doctors do two 24 hour shifts per month that's (2x12x75) $1.8 million a year scammed from people that came for help-in their weakest moments-afraid they might die-unable to negotiate and not knowing the situation. When I threw this calculation in their face they dropped the charges to keep me quiet I guess. ER doctors are only there to serve themselves. By the way...the doctor spent about 10 minutes with my wife TOTAL...the rest of the time we were there was waiting for her primary care doctor to authorize her release. This stuff is condoned by the Texas legislature and apparently by legislatures country wide...SHAME!
7
We need real exposure here, names and locations, so that we can avoid these hospitals like the plague.
And yes, it's time for single payer.
And yes, it's time for single payer.
3
Most most of these useless services should either be outsourced or automated and hopefully the savings go directly to consumers, but doubtful. The system in US is so non-transparent and complex that it gives people a nightmare to having to navigate thru in an unfortunate situation. When one is sick, one shouldn't have to go through these torture.
1
Ted Kennedy said it almost 50 years ago.
" Doctors and hospitals, charge too much "
" Doctors and hospitals, charge too much "
Thank goodness I don't live in the U.S. It is so very,very behind all other first world countries.
5
Like so many of the other commenters, I can add many personal experiences with fraudsters doctors as well. Whether it's testing that was sent to an out of network (and out of state) lab by my dermatologist, or my friend's bedside "internist" who was not aware that his patient's leg had already been amputated (and still had the nerve to bill him for services rendered). But why beat a dead horse. We know it, accept it, and seems like we have to live with this travesty.
Suffice it to say, this is corruption of the Nth degree, and surprise billing is no longer a surprise at all. Why aren't these criminals being held accountable?
Suffice it to say, this is corruption of the Nth degree, and surprise billing is no longer a surprise at all. Why aren't these criminals being held accountable?
4
Ms. Brown should not have to pay a penny of the $500 EmCare claims it is owned. It is illegal in California for doctors to balance bill for emergency care. That is codified by a 2009 California Supreme Court case, Prospect Medical Group v. Northridge Emergency Medical Group. If EmCare is balance billing consistently in this manner, it should be subject to a class-action suit.
4
I question some of the data in this study. The investigators looked at ER visit up coding after EmCare was hired, but did they cross reference that with the documented care? Perhaps EmCare doctors are more thorough in their evaluation so the higher level of coding is justified.
My question is why did the hospital hire EmCare in the first place. Was it difficult to staff the ER? Did the lower reimbursement that insurers paid contracted or in network ER doctors come into play? Was it more profitable for the hospitals to use EmCare?
The blame for out of network care must be laid squarely on insurers who offer subpar contracts to doctors, some paying less than Medicare rates. Without the ability to negotiate fairly with the large insurers like the Blues or Aetna physicians have no choice economically but to go out of network. Patient should be angry that their insurer is not paying the doctors who treats them. With premiums going up and more coinsurance responsibility being pushed back on the patient insurers are paying doctors less and less. Undervaluation of doctor care and big profit margins by insurers is why out of network care is increasing.
My question is why did the hospital hire EmCare in the first place. Was it difficult to staff the ER? Did the lower reimbursement that insurers paid contracted or in network ER doctors come into play? Was it more profitable for the hospitals to use EmCare?
The blame for out of network care must be laid squarely on insurers who offer subpar contracts to doctors, some paying less than Medicare rates. Without the ability to negotiate fairly with the large insurers like the Blues or Aetna physicians have no choice economically but to go out of network. Patient should be angry that their insurer is not paying the doctors who treats them. With premiums going up and more coinsurance responsibility being pushed back on the patient insurers are paying doctors less and less. Undervaluation of doctor care and big profit margins by insurers is why out of network care is increasing.
2
I have been an ED physician for EmCare, on and off, for almost 20 years and was a medical director of a large ED in Washington for another contract company for eight years. What your readers need to know is that ED physicians do not have any control over who contracts for the hospitals where they work, what contracts are signed for insurance plans, or even over coding and billing for the patients they see. All of that is in the control of the contract company. In addition, as someone who reviewed ED charts for many years as medical director, I saw no instances of fraud or misrepresentation of the complexity of any patient visits by any ED physician'. The physicians do not even know what a particular ED visit will generate for them, financially, and do not receive all of the monies quoted in the article, with as much as 25% going to the contract companies. Over the years, have found my fellow ED physicians to be some of the most hard working, dedicated and principled medical professionals out there, seeing all comers, with all conditions, at all times. And so please do not blame them for a corporately controlled healthcare system gone awry!
9
So physicians are not responsible for the terms of the contracting company they sign with? I'll readily concede that you and most of your ED colleagues are well intentioned and hard working. But surely you're not suggesting that you're to be absolved of the patient consequences for the agreements that you sign.
5
As someone who suffers from accident proneness and severe peanut allergy, I have had more than my fair share of emergency room visits. I can assure you that even though I am a pretty worldly guy with a PhD in pharmaceutical sciences, sitting down at the computer and doing research on local hospitals or quizzing admissions staff on billing (with the idea of maybe driving 20 miles down the road to a hospital that might have better pricing) has never been something I've considered while straining for breath or trying to keep adequate pressure on a deep cut. Nor should anyone have to. Universal health care is one of the factors that separates civilized nations from the others. No one should have to worry about whether he can afford treatment in a time of need.
9
This is not an indictment of Emcare; it's an indictment of the billing system, and of the price agreements between insurers and providers. The former should be fixed. Providers should not be able to gain by hiring experts at gaming the coding system.
The latter should be illegal. If I suffer cardiac arrest visiting a relative in Puckering Valley, I should not suffer further because no local provider is "in network" .
The latter should be illegal. If I suffer cardiac arrest visiting a relative in Puckering Valley, I should not suffer further because no local provider is "in network" .
1
The real problem is that the insurance companies are allowed to sell what is really partial coverage for healthcare costs.....the patient pays an insurance premium but the insurer only covers care by certain doctors (ones that agreed to do the work for lower pay).
3
This is basically abdication of responsibility by hospitals. The hospitals make in-network deals with insurers then hire staffing companies without requiring them to be in those very networks. It is as if the hospital just lets doctors walk in off the street and practice independently, as if the hospital has no control. But while hospitals have staffing issues, the doctors in this company would be OUT OF WORK if the hospitals didn't let them practice.
My suggestion is that at the admissions window of the ER, every patient give their insurance card and write a note saying that they will neither accept, nor be financially responsible for any out of network doctor, period. Then the hospital is on notice, and the out of network leeches can go pound sand.
My suggestion is that at the admissions window of the ER, every patient give their insurance card and write a note saying that they will neither accept, nor be financially responsible for any out of network doctor, period. Then the hospital is on notice, and the out of network leeches can go pound sand.
9
Uhhh...the leeches are the insurance companies that fail to provide coverage for their insured's healthcare. Sorry, but you may not use your Walmart gift card at Macy's.
Excuse me? You go to an Emergency Department (not too many around, little or no choice) and you find that the docs there are NOT part of your insurance company's coverage?
Something with that is very, very wrong.
Something with that is very, very wrong.
2
As a retired hospital-based patient advocate, I know this problem not only from the out of network standpoint, but also from the surprise that patients get when they get a deductible or co-pay bill from an in-network ER Doctor team. The patient goes to the ER with a true emergency, has no choice of who to see, is visited by a doctor with a name tag saying he or she works for that hospital, and believes the doctor is employed by the hospital. Weeks later they get a bill from the contractor (in the case of the hospital where I worked, it was Tesm Health) and then called my office to complain. They didn't understand why the ER doctor bill was not part of the co-pay or deductible charged by the hospital. After all, Dr. Smith had a name tag on saying he worked for that hospital. The care summary or discharge orders had the hospital name, not the name of the contractor. Your story is valid and disturbing. There is a bigger story of in-network doctors in ERs billing from outside the hospital with patients having no idea what us coming.
8
My elder father, who lives in France, got seriously ill (pneumonia) while we were all travelling there with family. Though we were hundreds of km from his home we were able to walk into a random primary care physician's office for an initial diagnosis, without an appointment. Three weeks of hospitalization followed, including initial treatment by a team of medics, and one full week in a public hospital ICU, two in a private clinic, three transfers by ambulance. As he has supplemental insurance in addition to the standard single payer coverage he had a private room throughout. The care was superb and high tech, he recovered fully, and the bill upon checkout was 0 euros, meals included.
23
That's how capitalism is supposed to work. A business that overcharges or provides bad service will lose customers and competitors that offer better products and services will thrive.
4
Yes, because when you're on the way to the emergency room of all places, THAT'S the time to shop around!
(Capitalism doesn't work in health care! We've been torturing ourselves as a country for 50 years to prove otherwise, but it's time to admit failure.)
(Capitalism doesn't work in health care! We've been torturing ourselves as a country for 50 years to prove otherwise, but it's time to admit failure.)
15
So when you're in a car crash, you are supposed to shop around for ambulance services and be together enough to interrogate every person approaching your gurney in the ER?
No, it's quite simple. If the hospital is in-network, then every provider in it should be required to be as well. If not, the doctors can go practice elsewhere. It is not like they can conjure patients on their own.
No, it's quite simple. If the hospital is in-network, then every provider in it should be required to be as well. If not, the doctors can go practice elsewhere. It is not like they can conjure patients on their own.
8
If you really want to see the absolute worst product or services that any business activity could possibly become, just make it a part of the national government.
3
When I called my own insurance company (a major insurer) with the procedure code for an MRI, and the name of the provider where I would have the test, and asked for the amount they would allow for that test, they actually refused to tell me. The customer service people kept saying, " only the higher ups have that information." Now, an MRI is an expensive test, and I have a high deductible plan, but the hospital said I should get the information from my insurer and the insurer suggested that I call the hospital. They both seemed to believe that I should have this test without having any idea of what it would cost me! I never understood why my insurance company behaved that way, and I still haven't had the test.
Politicians keep saying that we must shop around for the best deals on healthcare. Good luck with that.
Politicians keep saying that we must shop around for the best deals on healthcare. Good luck with that.
25
I had something very similar happen to me. I know politicians aren't really sincere about the patients shopping around for the best deal because none of the bills being talked about have any means to force providers and insurers to disclose prices.
1
Privatized healthcare in its true form. A ripoff scheme. Hospitals who are considering hiring these companies should be held responsible for covering these bills.
5
This is why patients are unable to shop for medical care. One has no idea who is in network or out of network. If the hospital is part of your insurance plan you expect their doctors will too. You shouldn't have to get a list of doctors who take your insurance before you are treated in the ER. This is robbery pure and simple. It's another argument for single payer insurance. Any hospital that accepts government dollars has to accept the insurance.
8
Every time I read something in the NYT about health care, insurance, hospital costs etc, in the US, I boggle. This is third-world stuff. How can a country that is so advanced in many ways be so backward in many other ways? How can a country let greed corrupt so many of the essential requirements of its citizens? Why are things like health, taxes, infrastructure funding, voting etc, etc made so unnecessarily complicated in the US? As always the answer can be found if you follow the money.
30
You are correct in your conclusion - we have become a third world country in health care and many other facets. We may be the first country to willingly and voluntarily abdicate first world status.
But we have guns. That is what we have chosen.
But we have guns. That is what we have chosen.
7
Our health care, education and justice systems are being outsourced to an unscrupulously brutal Wall Street industry syndicate. The execs who run these business easily make bank on a simple moral code - you will pay any price to survive.
Consider that Democratic Government is a way of organizing and enforcing a set of rules and values such that people are not taken advantage of by a small minority of elite plutocrats/oligarchs. In this simple task, the US Government has failed. Neither Democrats nor Republicans have the courage to challenge Wall Street corruption. Together our elite intellectual and political classes are behaving in a treasonous way. They are using their purchased political power to limit middle class power and harvest us like fish in a barrel.
The health care industry doesn't provide health care services, they hold us hostage and demand a ransom. We need a health care revolution. We can begin by investigating and prosecuting greedy, price gouging CEOs for anti-trust or other criminal activity.
Wall Street is exploiting us, Congress is failing to represent us. America is looking more and more like a failing, despotic 3rd world country with lots of weapons.
Consider that Democratic Government is a way of organizing and enforcing a set of rules and values such that people are not taken advantage of by a small minority of elite plutocrats/oligarchs. In this simple task, the US Government has failed. Neither Democrats nor Republicans have the courage to challenge Wall Street corruption. Together our elite intellectual and political classes are behaving in a treasonous way. They are using their purchased political power to limit middle class power and harvest us like fish in a barrel.
The health care industry doesn't provide health care services, they hold us hostage and demand a ransom. We need a health care revolution. We can begin by investigating and prosecuting greedy, price gouging CEOs for anti-trust or other criminal activity.
Wall Street is exploiting us, Congress is failing to represent us. America is looking more and more like a failing, despotic 3rd world country with lots of weapons.
12
I was charged for an out-of-network Doctor who read x-rays during an ER visit. I had to call the Hospital Administration only to learn the Doctor was not part of its network "yet". I then had to call my insurer to explain what was stated by the Hospital; write a letter to the hospital refusing to pay out-of-pocket for a decision it made to utilize a physician it knew had not yet received his fully staff credentials. I then hand to contact my insurance plan's administration to inform then I had no intention to pay the bill (my insurer had refused to pay because it was an out-of-network physician). I then wrote them a letter requesting them to contact the Hospital why it did not adhere to my insurance provisions when it had all of the information in its system. After several weeks- I received letters from the Hospital and my insurer with a new EOB writing off the Bill.
I was only able to follow through because of decades of being insured and seeing year-after-year how changes always seem to benefit the providers of service and not the insured.
I was only able to follow through because of decades of being insured and seeing year-after-year how changes always seem to benefit the providers of service and not the insured.
19
Just another example of a for profit private healthcare "company" whose only goal is to maximize profits at the expense of its "customers" disguised as patients.
Just for a moment, think of the healthcare horror that will unfold if, somehow Republicans are able to secure enough votes to pass their "repeal only" bill of the ACA?
Just for a moment, think of the healthcare horror that will unfold if, somehow Republicans are able to secure enough votes to pass their "repeal only" bill of the ACA?
11
If the Republican health care bill passes, EmCare's methods of increasing emergency room bills will prevail. How fortunate for EmCare executives and shareholders. It's a pity that ninety percent of the nation does not have the financial resources to be able to invest in EmCare, but for the Rich people who do, Republicans will reward them by reducing taxes upon their investment income. For every body else, reducing medicaid assures we will be punished to encourage us to work harder.
11
Touché, my friend!
This has nothing to do with the Republicans healthcare bill.
What's most interesting about this billing practice (known as Balance Billing) is that there is a new trend in state governments passing laws that require payers and insurers to pay the entire bill if the service is an emergency. Both Maine and Florida passed these laws this past year.
Therefore, regardless of what the healthcare provider (facility, doctor, etc) bills, if it's an emergency service and they're out of the insurers metwork, the health insurance has to pay the entire bill.
People wonder what the problem with our healthcare system is, why people's premiums keep rising and they choose to ignore the true root of the problem.
Therefore, regardless of what the healthcare provider (facility, doctor, etc) bills, if it's an emergency service and they're out of the insurers metwork, the health insurance has to pay the entire bill.
People wonder what the problem with our healthcare system is, why people's premiums keep rising and they choose to ignore the true root of the problem.
2
The fact that we need "a biller and coder" speaks volumes about one of the many things that is wrong with our health care system.
12
"Sometimes, insurance companies will offer only low payments, leaving physicians no choice"
Who needs to make $500 for two minutes' work?
Who needs to make $500 for two minutes' work?
3
Someone who has half a million dollars in school debt?
5
Uh, 200K?
Why should medical school cost half a million dollars?
I visited Cedar Sinai emergency room with an asthma attack. In addition to everything else, I got a $500 bill (my portion) from a doctor who saw me for less than 3 minutes. I wrote him a scathing letter and the charge disappeared.
16
This is the "free market" working exactly as intended. This is why we need single payer.
18
How would Single Payer solve this? Instead of our premiums going up each year it would be our taxes.
Oh wait, would we make all these businesses part of the Federal Government or cap the amount of money they can make treating patients? I wonder how that's been working for the VA.
Oh wait, would we make all these businesses part of the Federal Government or cap the amount of money they can make treating patients? I wonder how that's been working for the VA.
1
We need to remember that taxes may go up with a single payer system, but one wouldn't be paying additionally for medical insurance. I'd gladly have my family's tax bill increase $500 a month if I didn't have to pay $700 in monthly premiums. The tax wouldn't be additional; we'd just pay a different way.
11
The VA is socialized medicine. The doctors are employed by the VA. Single payer would be more like Medicare for all. The doctors and hospitals would not be employees of Medicare.
Nothing new, but these kind of articles are good for showing people that it isn't only the pharmaceutical companies that make our healthcare system so expensive.
Every hospital employs coders who spend their day sifting through patient care documentation looking for "legal" ways to get the biggest reimbursement for their employer. They also bring in consultants who will review past hospital admissions looking for missed opportunities to get more money.
You want to know why it is so hard to get the Democrats or Republicans to get us to single payer? There are too many people making so much money off our healthcare system that will do anything to prevent the spigot of money from being turned off.
Every hospital employs coders who spend their day sifting through patient care documentation looking for "legal" ways to get the biggest reimbursement for their employer. They also bring in consultants who will review past hospital admissions looking for missed opportunities to get more money.
You want to know why it is so hard to get the Democrats or Republicans to get us to single payer? There are too many people making so much money off our healthcare system that will do anything to prevent the spigot of money from being turned off.
33
Now does everyone understand why the US spends twice as much per person on health care than in Canada, the UK, and Europe and the US is in 31st place in life expectancy?
20
There is nothing new about this story. When I paid claims for a medical group twenty years ago the ER doctors at one of the larger hospitals did the same thing. Over billing was the norm for this group. The physician report did not match the billing in terms of time and service. The patient ended up with a big debt. The medical group could not argue with the ER group since there was no contract. Out and out piracy.
An ambulance transports the patient to the nearest hospital. Then come the bills. Ambulance companies bill in part by mileage. When a processor paid a claim for an ambulance group they needed a map to verify this mileage. This was often inflated. Someone needs to look at this service too.
An ambulance transports the patient to the nearest hospital. Then come the bills. Ambulance companies bill in part by mileage. When a processor paid a claim for an ambulance group they needed a map to verify this mileage. This was often inflated. Someone needs to look at this service too.
13
You get more of what you subsidize and don't control.
2
America has the most expensive healthcare in the world. Sadly, we have nowhere near the best. And it is groups like this that drive both the high cost and the low outcome.
20
Oh it IS the best -- the best at extracting money which is its real purpose, sadly.
1
Perfect example here of monopoly rents in health care. Simple solution for out of network abuse: If a hospital is in network, then doctors working the hospital (privileges) must accept in network compensation. ie No participation, no privileges. We need to correct the no insurance abuse as well. Upon admission if there is no insurance, the only requirement is emergency stabilization until ability to pay is verified. Combine with a dose of tort reform.
13
And if they can't pay, then what? Even under those dire conditions, I doubt you will find many doctors who would feel confortable playing God, especially if they knew there were treatment options for the patient. Of all the western industrialized nations, the patient you describe would only face that sad situation in America.
1
As a practicing ER physician for over 38 years, I think it is worth pointing out that by in large the ER physicians that work for these contract companies such as EmCare and TeamHealth are simply paid by the hour. We don't get paid more for ordering tests, we don't get paid more for seeing in network or out of network patients, we get paid the same whether it's busy or slow. We each sign a contract and agree to work for a specific dollar per hour amount, period. I am as appalled as anyone else by the bills people get from the company I work for. If I had another choice, I would likely choose to work for someone else, but every hospital ER within a days drive from here is contracted with one of these companies, many of them owned by investment firms who charge exorbitant fees and then pass those dollars on to their investors, NOT the ER doctors.
63
Then quit and show some backbone or you're no better than the other sharks out there.
1
That contract giving you license to work in a hospital should come with a clause requiring you to participate in all the networks that the hospital does. Otherwise, you don't work. Deal?
1
I agree. People are blaming the doctors when for the most part they should blame the management. Many doctors are as helpless as we are.
Writing as a physician in practice for over 45 years: the answers are simple: everyone has a right to medical care, health care is a true part of our infrastructure and fee for service needs to be stopped. Also the right of large groups to negotiate drug and equipment prices. (e.g. Medicaid). Many more ideas, but the basic principle is that lower cost efficient medical care is possible. That, of course, would include outrageous ER or hospital charges. It can be done.
11
Also writing as a physician with five decades of EMERGENCY MEDICINE practice, would you have us work for free? And unlike all physicians with an office practice , we MUST treat and see all patients, including the uninsured abusice and dangerous ones. Why shouldn't we be able to charge reasonable fees comparable to any other specialty based on acuity and complexity, and if insurance balks charge the patient directly?
8
John, the hospital should pay you a fair salary, not based on procedures ordered.
And part of the contract that PERMITS you to work in an ER should require you to be in every network in which the hospital participates. No problem if you're salaried, right!
And part of the contract that PERMITS you to work in an ER should require you to be in every network in which the hospital participates. No problem if you're salaried, right!
2
Medicare for all would greatly reduce this type of predatory behavior.
There is no excuse other than to provide profit for a select few practitioners and pharmaceuticals / medical device makers.
If we can wean Congress off the addictive influence of lobbying we could actually join the rest of the developed world in offering universal healtcare....
There is no excuse other than to provide profit for a select few practitioners and pharmaceuticals / medical device makers.
If we can wean Congress off the addictive influence of lobbying we could actually join the rest of the developed world in offering universal healtcare....
5
How would Single Payer solve this issue?
Do you know anything about how doctors and facilities that are not a part of the governments health care system operate in countries that have universal health care?
Do you know anything about how doctors and facilities that are not a part of the governments health care system operate in countries that have universal health care?
Single Payer would solve the problem because all doctors would be required to work for government pay. Why should they get rich off the backs of the poor and downtrodden?
2
Ah! First do no harm!!!!
I certainly have been surprised by extra bills form someone I never knew in a hospital.
I guess we need to ask anyone who touches us in a hospital if the person is in network. But isn't it the responsibility of the hospital and its staff to inform us of any out-of-network coverage? In the ER most of us are in too much shock to even ask a question!
I certainly have been surprised by extra bills form someone I never knew in a hospital.
I guess we need to ask anyone who touches us in a hospital if the person is in network. But isn't it the responsibility of the hospital and its staff to inform us of any out-of-network coverage? In the ER most of us are in too much shock to even ask a question!
5
Brilliantly important study, article and comments. I am so grateful to the NYTimes and readers.
10
The biggest problem we have in the health industry is 1. Board control of the supplier of doctors so the supply and demand market is not balanced , solutions- allow more med students and increase doctor numbers and recruit oversea doctors 2. Over prescription of Drugs , people need to have more health habit and not told by their doctors they are sick and need take this drug or that drug. Many health issues are caused by terrible habits and diets and drug only make it worse. -solution establish heathy habit 3. Heath care industry morale decline , more and more doctors try to get patients to have exams that are not necessary just to increase their overall income. - solution do you own research and always know why .
3
The practices described in the article don't benefit the individual doctors involved. They work for a for profit publicly traded company (EMCare) who got a contract to staff the the emergency room. The doctors get paid by the hour and are forced to order tests or bill at a higher amount in order to keep their jobs as evidenced by the whistle blower lawsuit. When a staffing company has every hospital contract in a city, doctors are forced to move or put up with the job.
Very few doctors work for themselves any more because hedge funds, private equity, and for profit companies are the ones that can get contracts with hospitals and are the only ones hiring.
Very few doctors work for themselves any more because hedge funds, private equity, and for profit companies are the ones that can get contracts with hospitals and are the only ones hiring.
4
There is a simple fix to out of network ER billing. Pass a law that all doctors are treated as in network.
Second, pay doctors a salary.
Third, fine hospitals that admit patients who don't need to be admitted.
Likewise fine doctors who order unnecessary tests.
Finally, implement single-payer.
Second, pay doctors a salary.
Third, fine hospitals that admit patients who don't need to be admitted.
Likewise fine doctors who order unnecessary tests.
Finally, implement single-payer.
8
The Queen called, she wants her National Health idea back. Find me an American who will accept a system that makes you wait 4 months for an appointment to treat the flu.
5
Cite your concrete examples. Nonsense.
The doctors hired by EmCare are paid a by the hour wage. They don't profit from the crazy billing; the company and Wall Street does. EmCare is owned by Envision (EVHC). The whistle blower lawsuit against EmCare alleges that doctors were forced to order tests and admissions in order to keep their job.
Wall Street has taken over healthcare and doctors are just your hourly service workers at this point who don't have any control.
Wall Street has taken over healthcare and doctors are just your hourly service workers at this point who don't have any control.
5
A doctors off made a mistake and neglected to send my insurance information with a lab test. The lab billed me $100 for the test instead of my $10 co-pay.
When I informed the lab of the error, they told me that the new bill was $4, even less than my co-pay.
A person with no insurance would have to pay the full freight for a test that the lab would do for under five dollars - something is wrong with that.
When I informed the lab of the error, they told me that the new bill was $4, even less than my co-pay.
A person with no insurance would have to pay the full freight for a test that the lab would do for under five dollars - something is wrong with that.
6
You may have actually paid the same amount.
You paid one portion ahead of time, with your insurance premium.
You paid the second smaller portion yourself, as your copay.
This serves as a disincentive to you, as the patient, from seeking unnecessary tests.
You paid one portion ahead of time, with your insurance premium.
You paid the second smaller portion yourself, as your copay.
This serves as a disincentive to you, as the patient, from seeking unnecessary tests.
1
Whatever happened to the Consumer Protection Bureau? Wasn't this government body setup to protect consumers (the American public) from the predatory corporations in this country? Remember how hard the Republicans fought to keep that protection away from us? Looks like, due to it's absence they succeeded.
5
If Republicans want a free market health care system, shouldn't prices be transparent rather than a trade secret??
19
“The whole thing is really a mess,” he said. “Progress is really slow.”
The whole thing is a mess because state legislators work for the medical and pharmaceutical industry and not the people who elect them, just as at the Federal level.
In America, our Roberts Supreme Court has called unlimited money in politics "free speech". In other countries it is called what it is, unlimited corruption.
The medical industry is just one more sector of our society where predators lurk and can ruin your life.
The whole thing is a mess because state legislators work for the medical and pharmaceutical industry and not the people who elect them, just as at the Federal level.
In America, our Roberts Supreme Court has called unlimited money in politics "free speech". In other countries it is called what it is, unlimited corruption.
The medical industry is just one more sector of our society where predators lurk and can ruin your life.
21
Why isn't it required that every hospital post the names of outsourced doctors in every department. The patient can choose, in advance, to avoid hospitals using outsourced docs.
Isn't it the responsibility of the insurance company to ensure that the hospitals in-contract provide enough in-house doctors?
Isn't it the responsibility of the insurance company to ensure that the hospitals in-contract provide enough in-house doctors?
8
Premium the hospital doesn't want to pay the doctors s market based going salary...if they did they wouldn't need to use a external staffing company!
Among the benefits of insurance companies vs single provider government healthcare. My insurance company refused to pay for the ambulance taking me to the ER after I was hit by a truck. They said I was responsible to have the ride pre-authorized, in spite of the fact I was unconscious (they eventually relented after a dozen phone calls, knowing I was afflicted with a severe brain injury).
13
Another workaround that I saw with my mother's care (she has dementia so does not know what is happening when she goes to the doctor) Is that she was not billed through medicare for the ambulance ride or for her hospital visit. I receive a bill months later from the ambulance company saying I owe them over $1,000. I filed with medicare services and because I received the bill so late and it took time to file, I was too late to file for Medicare coverage for the ambulance. Who's responsibility is that? The patient who has dementia, the son who tries to provide for her needs at some distance away from her, or the ambulance company seeing that she was old enough to definitely have Medicare and chose not to figure out how to push their bill for her through Medicare? I wonder if they would rather receive a Medicare reimbursement or a private pay reimbursement? Anyone else see this happening?
19
I am an ER physician working for EmCare. I also work for other companies in different ERs and aware of many of the issues mentioned in the article. The thing I do not understand is wh EmCare is singled out for the practices which are widely prevelent in the industry. Infact, EmCare has put the least pressure in terms of billing and admissions from my personal perspective. As physicians, we are paid a fixed wage which is not ideal for physicians, but it puts the least pressure on us in terms of ordering tests or admissions and is best for the patient as there is no incentive or pressure to do anything more than needed. Agree that physicians prefer to work for the model where the job of recruiting physicians is outsourced but that is because we do not have to deal with the administration who most of the time are not aware how the ERs work. I used to be the ER medical director at one hospital where I was directly employed by the hospital group and used to face much more pressure to increase the admission rate and to transfer patients to the sister hospital. Working for a group frees the ER physicians of such constraints and personally able to concentrate on patient care.
12
Reply to ER Physician Mathew:
"As physicians, we are paid a fixed wage which is not ideal for physicians".
That's interesting because I have tried to stick with salaried doctors and HMOs because I find it "not ideal" that a doctor's decision might be influenced by something other than the best treatment alternative for me.
So far it has saved me an invasive back surgery. Think how many fewer surgeries there would be, especially on knees, if evidence based care was the standard, and not openings in the surgeon's calendar to fill.
"As physicians, we are paid a fixed wage which is not ideal for physicians".
That's interesting because I have tried to stick with salaried doctors and HMOs because I find it "not ideal" that a doctor's decision might be influenced by something other than the best treatment alternative for me.
So far it has saved me an invasive back surgery. Think how many fewer surgeries there would be, especially on knees, if evidence based care was the standard, and not openings in the surgeon's calendar to fill.
13
In trying to determine whether EmCare was involved with my local hospital (Community Hospital of Monterey Peninsula), I went to its website. Its services are grouped under the heading Envision Physician Services, touting the "envision difference". The link for "locations" (https://www.emcare.com/the-envision-difference/locations) displays a map showing EmCare hospitals "nationwide." These are indicated by white circles on the map.
You'd expect that clicking on a circle would produce the name of the hospital, or at least its location. Not so. Beyond showing lots a circles in various states, the map produces no useful information about EmCare's "locations." Why the company would even bother to display a map is beyond me, unless it's just a PR gimmick to show that EmCare has lots of revenue-producing activities across the country. Apparently the "Envision difference" is simply that unlike many other enterprises, this one doesn't even want you to know where it's doing business - disturbing, since medical care is a public health concern, not a private-enterprise hustle, or should be.
You'd expect that clicking on a circle would produce the name of the hospital, or at least its location. Not so. Beyond showing lots a circles in various states, the map produces no useful information about EmCare's "locations." Why the company would even bother to display a map is beyond me, unless it's just a PR gimmick to show that EmCare has lots of revenue-producing activities across the country. Apparently the "Envision difference" is simply that unlike many other enterprises, this one doesn't even want you to know where it's doing business - disturbing, since medical care is a public health concern, not a private-enterprise hustle, or should be.
9
I had the same problem with an "out of network" anesthesiologist. Chose an "in network" surgeon and an "in network: hospital. It seems the (county owned) hospital had an exclusive (monopoly) contract with the only local anesthesiology practice that wasn't "in network". I suppose I was supposed to vet every sub-specialty that I could be exposed to - for an "outpatient" surgery.
We should be surprised that a "for profit" provider corporation is first and foremost about profit?
We should be surprised that a "for profit" provider corporation is first and foremost about profit?
9
The United States of America is the most valuable "for profit corporation" to have ever existed in the history of the world.
5
Right! That's why we shouldn't be surprised.
2
I had an insurer classify the anesthesia prior to a surgery an additional admission to the hospital. It was easier just to fork over another $500 rather than risk a credit score hit and fight it out.
2
It appears not everything that's supposedly broken with the ACA has something to do with the insurance marketplace. I wonder how Republicans are planning to fix the problems outlined in this article and the "dated" study.
15
My AC broke down after 5pm the other day. Tech came and blew out blocked evaporator line. it took less than 30 minutes, but since it was an emergency call "after hours" the bill was over 360.00 dollars (I live on east coast). Although what he did looked easy, i realize that i would have been lost without him. I called him and he performed a service that I requested so I paid him and thanked him. Yes, I understand the faults in the analogy. I had no expectation of "coverage" and certainly I was in a position where I could say no. However, I think it is important to put things in some perspective. It never ceases to amaze me that people who drive up in an expensive leased car and talking on the latest iPhone complain about a "500 dollar" ER bill.
With high deductible, co- insurance, and copays- it is unrealistic to expect full coverage. I don't have all the answers, but even single payor will not prevent medical bills. A safety net is needed for those who can't afford care. For the rest of us; we need to try to have the best health insurance we can afford, ask a lot of questions, plan before we get sick (even if this means making calls and asking if they accept insurance before becoming ill), pay our bills, and hope we can stay out of the system.
With high deductible, co- insurance, and copays- it is unrealistic to expect full coverage. I don't have all the answers, but even single payor will not prevent medical bills. A safety net is needed for those who can't afford care. For the rest of us; we need to try to have the best health insurance we can afford, ask a lot of questions, plan before we get sick (even if this means making calls and asking if they accept insurance before becoming ill), pay our bills, and hope we can stay out of the system.
7
I am not sure I follow your logic. I read nothing about iPhone owning, expensive car driving people complaining about a $500 charge. The hospital’s previous physicians had been charging $467 for the same emergency service EmCare’s charged $1,649 for. This is more like your AC guy showing up to perform the same repair at the same off hour at quadruple to what he charged on the last visit because they got a new manager in the service dept.
Plus my company has great insurance, but when my wire had cancer there were all kinds of charges on the bills we received, and some showed up as out of network at a higher price because that one service was performed by a vendor like these people. We chose a hospital in our Network too, so how are you suggesting we made bad choices? Unless I missed something you said I totally do not agree.
Plus my company has great insurance, but when my wire had cancer there were all kinds of charges on the bills we received, and some showed up as out of network at a higher price because that one service was performed by a vendor like these people. We chose a hospital in our Network too, so how are you suggesting we made bad choices? Unless I missed something you said I totally do not agree.
7
Single payer will not prevent medical bills. In Canada it is illegal to extra bill for medically necessary services. i.e. people can be billed for insurance forms..cosmetic surgery and treatments such as botox, refractive surgery. It.varies by the province. Ontario has a lively GP Psychotherapy movement..not sure about current status as the psychiatrists were fighting it. There are some private groups that charge by the year. Those docs are not supposed to bill the public insurance.
3
Not the point of this article.
The real problem here lies with insurance companies. There is an inherent conflict of interest when an insurer undertakes a fiduciary duty to its insureds to provide coverage for the care for which they have contracted, yet the self-same insurer owes a entirely conflicting duty to its shareholders to maximize profits by withholding as much expenditure as possible.
There is a simple solution here. If one has an emergency, it should be covered. That is to say, no doctor should be considered "out of network" if consulted on an emergency basis. This would solve the problem. Of course, so would single payer healthcare for all. National healthcare for all would be the best route by far. If you're not sold on the idea, ask yourself, "Has any country with national healthcare actually decided it is not worth it?"
There is a simple solution here. If one has an emergency, it should be covered. That is to say, no doctor should be considered "out of network" if consulted on an emergency basis. This would solve the problem. Of course, so would single payer healthcare for all. National healthcare for all would be the best route by far. If you're not sold on the idea, ask yourself, "Has any country with national healthcare actually decided it is not worth it?"
26
Our country has the single highest amount of foreign patients seeking treatment (at full cash prices) of any other nation. Why do you suppose that is?
1
@EG. Great idea. But, there should also be a board of 3 physicians and 3 patients that review each emergency and see if it is actually an emergency. If so, it is covered. If not, it is patient responsibility. Then you would have a great system, free from ER abuse, yet protect patients with an actual emergency.
1
I suggest you google Medical Tourism and see where Americans travel abroad for healthcare and how many do it. You are in for a rude awakening.
"Doctors would 'prefer that we had better payment and better negotiation with the insurers, and the patients would be covered,' he said."
Of course, the ER industry wants to be free to charge exorbitant fees and be paid by insurance companies so that patients don't gripe. Patients have no bargaining power over ER prices and the the industry charges arbitrarily - the insurance companies do have bargaining power and won't submit to extortion.
The current medical industry is overwhelmed with greed and inefficiency. Patients and providers spend an inordinate amount of time arguing with insurance companies and each other. And failure to pay medical bills, no matter how unjustified exposes the patients to collection agencies and adverse credit reports that raise their insurance and credit card rates.
Of course, the ER industry wants to be free to charge exorbitant fees and be paid by insurance companies so that patients don't gripe. Patients have no bargaining power over ER prices and the the industry charges arbitrarily - the insurance companies do have bargaining power and won't submit to extortion.
The current medical industry is overwhelmed with greed and inefficiency. Patients and providers spend an inordinate amount of time arguing with insurance companies and each other. And failure to pay medical bills, no matter how unjustified exposes the patients to collection agencies and adverse credit reports that raise their insurance and credit card rates.
12
ERs are required to see whoever shows up at their door, regardless of ability to pay or insurance. Eliminate that demand, signed into law by Reagan and perhaps things might change some.
6
Carol Ray - and if the ER refuses to treat you we'll let you die on the sidewalk. Sounds like a perfect answer.
4
When my 85-year-old father was in the hospital due to an infection from a biopsy (the biopsy was negative - great), we were concerned that the nurse would bring in 12 pills for him to take with one cup of water which, of course, made him very ill (severe and immediate blood pressure drop, etc.). We learned that 11 of those pills were from a cardiologist! I called the doctor and told him my father had a nearly new heart put in him a few years before and he would not be taking any of his medication and, if the doctor did not refrain from visiting and billing my father, I would grab a hold of his "extremity" and put it in such a tight knot that the best surgeons in the world would not be able to untie it. My father then only got the one pill his doctor prescribed and quickly recovered.
23
Yes, overtreatment has consequences beyond the financial, as your story vividly illustrates.
Good for you!
Good for you!
1
Where is the accountability for these types of abuses of patients?
13
Accountability for abuse of patients ??
You jest, methinks ...
The only accountability is to the corporate bottom line, the line you and I, and everyone else knows, is maintained and improved on, specifically through one kind of corporate abuse or another.
The wellbeing and welfare of the working class is set at a basic survival level, such level determined by our corporate masters at the barest minimum necessary to keep the workers dependent, and physically able to work.
A critical all important, component of the nurturing of the working class, is fear, constant fear of loss of work, resulting in loss of livelihood, home, and family.
You jest, methinks ...
The only accountability is to the corporate bottom line, the line you and I, and everyone else knows, is maintained and improved on, specifically through one kind of corporate abuse or another.
The wellbeing and welfare of the working class is set at a basic survival level, such level determined by our corporate masters at the barest minimum necessary to keep the workers dependent, and physically able to work.
A critical all important, component of the nurturing of the working class, is fear, constant fear of loss of work, resulting in loss of livelihood, home, and family.
18
Yes, this is all working as designed.
Get rid of health insurance companies. They add many unnecessary costs without adding any value to the process of delivering health care.
28
The cure?
Three words.
Medicare for all.
Three words.
Medicare for all.
33
My doctor doesn't accept Medicare, but I found 2 Soviet educated veterinary homeopathic faith healers who do.
I agree that this is all cruel and ridiculous. One piece that is lost in this article is the fact that EMTLA, the emergency medical treatment and labor act, requires ERs to treat all who arrive for care. It doesn't matter if the people have insurance or not. The effect is that ER physician groups have a huge part of their business that pays nothing or that pays well below the cost to provide that care. Medicaid in Michigan only pays on average about 17% of physician bills. ER doctors have a much higher proportion of patients that are Medicaid or low income uninsured than any other specialty.
EmCare is extreme but does anyone have a good solution that is likely to get implemented? No state is going to pay fair Medicaid rates at this point. Some communities are so short of other doctors willing to see Medicaid doctors for scheduled care that Medicaid patients go to the ER to make sure that a doctor will see them timely at all. Insurance companies refuse to pay more to cover the costs of patients with low or no insurance. It is no wonder There is shortage of ER doctors who gravitate to ER employment that pays them the best.
This leads to ER doctors who have to cover the cost of caring for everyone who walks in by overcharging the few who can pay. This is capitalism and small government. Until people understand this and are willing to correct it, our country has voted in favor of exactly this.
Single payer is only solution.
EmCare is extreme but does anyone have a good solution that is likely to get implemented? No state is going to pay fair Medicaid rates at this point. Some communities are so short of other doctors willing to see Medicaid doctors for scheduled care that Medicaid patients go to the ER to make sure that a doctor will see them timely at all. Insurance companies refuse to pay more to cover the costs of patients with low or no insurance. It is no wonder There is shortage of ER doctors who gravitate to ER employment that pays them the best.
This leads to ER doctors who have to cover the cost of caring for everyone who walks in by overcharging the few who can pay. This is capitalism and small government. Until people understand this and are willing to correct it, our country has voted in favor of exactly this.
Single payer is only solution.
27
How about a follow-up article telling us how to protect ourselves from this type of organized crime?
19
See your primary care doctor for non-emergencies instead of using the ER for convenience. They are cheaper and more transparent.
2
And in an emergency?
1
yes because when an ambulance brings in an unconscious accident victim they're really able to ask "are you in my network.? do you work for this hospital?"
1
Basically, doctors should be on a salary as opposed to a pay for service model.
13
why only doctors...i think the whole country should. socialism for all. perhaps everyone should make minimum wage
Until the pharmaceutical companies are on a salary basis instead of a highest price the market will bear model, we won't see an end to any of this madness.
2
EmCare ER docs are paid hourly. The enormous profits go to the publicly traded corporation. The problem here isn't with the doctors. They don't determine the contracts or fee schedule.
2
Insurance companies that rely on a network of physicians should be obliged to create a sufficiently large network to provide care for the people they cover. They should also provide complete coverage for medical emergencies. If you have insurance you shouldn't have to pay.
7
Thank you for the heads up. How about publishing a national list of hospitals that use EMCare so we can avoid them? It would also be great to have a national rating of hospitals that compared average billing rates for the various services they performed. As long as these businesses are allowed to operate under the cover of darkness, their criminal behavior will continue. All of this strengthens the argument for single payer healthcare. How do we defang the insurance industry lobbyists?
15
How do you avoid an EmCare hospital in rural areas when they staff the hospitals when there are not physicians in place to cover the shifts. Good luck with that in an emergency. Also, hospitals with full time staff still rely on EmCare if they are short a staffing for that shift. Again, good luck with that.
1
Contracting for Physician services is more and more common in the field of medicine, particularly in rural areas and regions that are not as "desirable" to live in. This has the necessary, and fully expected result, of bringing in MD's that are not committed to the community that they are serving. I use the term serving explicitly because "service to the community" is almost always part of the "Mission Statement" of hospitals in the United States and should certainly be a required expectation of all members of a hospitals medical staff. With that said, I have no sympathy for MD's who stoop to this kind of billing behavior and even less for the Administrators of these hospitals who voice surprise that something like this could happen. There is little concern for the community demonstrated here. I have little doubt that EmCare is quite happy with the out-of-service MD billing because they undoubtedly keep a very high percentage of the fee paid as an Administrative charge, something the Hospitals must know if they paid any attention to the contract they signed with EmCare.
8
Surprise billing is not a bug, it's a feature of our so-called health insurance system. I had no idea that the x-ray tech wasn't in-network when I went to my in-network hospital ER for a possible broken nose. Surprise!
What makes hospitals think that patients don't care if certain docs aren't in-network? They should be REQUIRED to make sure every doc they contract with is part of whatever insurance networks they are telling their patients they are part of.
This in/out network business is ridiculous, and that's why we have to make hospitals feel the pain of it. They can't shrug it off with the expectation that the patients will just have to to eat the cost, while they are profiting. In fact, very single aspect of the health industry has to suffer in order for sanity to prevail with a singe payer system. Let's start with this EmCare business.
What makes hospitals think that patients don't care if certain docs aren't in-network? They should be REQUIRED to make sure every doc they contract with is part of whatever insurance networks they are telling their patients they are part of.
This in/out network business is ridiculous, and that's why we have to make hospitals feel the pain of it. They can't shrug it off with the expectation that the patients will just have to to eat the cost, while they are profiting. In fact, very single aspect of the health industry has to suffer in order for sanity to prevail with a singe payer system. Let's start with this EmCare business.
17
I had a similar experience with an ER doc. I even looked him up on my insurer's provider listing while I waited to have my inflamed appendix extracted and by golly he was listed, phew. Then when I got his bill and started making calls I found out he was only covered when he worked at his office. When he was at the ER he was working independently and didn't have a contract with my insurer. Luckily for me he was only responsible for approving my admission and discharge so his bill was only a few hundred. If the surgeon had been playing the same game I would have been on the hook for the $10,000+ surgery.
Whatever the opposite of "up front pricing" is should be illegal. How can I enter a binding contract to pay when I don't know the terms?
Whatever the opposite of "up front pricing" is should be illegal. How can I enter a binding contract to pay when I don't know the terms?
31
And if the question is "why?" the answer is "because they can".
Think EpiPen
Think Insulin
Think Martin Shkreli
Now think "Universal Health Care"
Think EpiPen
Think Insulin
Think Martin Shkreli
Now think "Universal Health Care"
28
Rehab Institiute of Chicago (now Shirley Ryan AbilityLab) did "surprise billing" to me last summer. Waited for an appointment, gave insurance info days ahead of time, saw the doctor who recommended physical therapy, made an appointment for followup. Two days later they called, said I was out of network, cancelled my PT (forcing me to start over in seeking treatment for an acute injury), and never filed an insurance claim. Now they want $641 for a brief assessment.
Single payor, anyone?
Single payor, anyone?
12
For months we were told by Paul Krugman and Hillary Clinton that Bernie Sanders' "Medicare for All" proposal was unrealistic and unaffordable. Under the predatory system we have, all health care is becoming unaffordable and inaccessible.
We could simply adopt Canada's system with a few tweaks, but we'd have to give up $billions in new Navy ships and aircraft so sophisticated that they don't work, or a couple of pointless wars in the Mideast. And the medical cabal (private insurers, drug manufacturers, hospitals, and doctors) would have to scale their profits back from "obscene" to "excessive."
As a Canadian doctor once observed, Americans don't care if a patient "falls overboard" as long as they don't have to hear the splash. Our fear of "socialized medicine" -- that exists almost exclusively in the UK and our own VA -- is so ingrained, we can't admit "capitalized medicine" is bankrupting us just before it kills us.
We could simply adopt Canada's system with a few tweaks, but we'd have to give up $billions in new Navy ships and aircraft so sophisticated that they don't work, or a couple of pointless wars in the Mideast. And the medical cabal (private insurers, drug manufacturers, hospitals, and doctors) would have to scale their profits back from "obscene" to "excessive."
As a Canadian doctor once observed, Americans don't care if a patient "falls overboard" as long as they don't have to hear the splash. Our fear of "socialized medicine" -- that exists almost exclusively in the UK and our own VA -- is so ingrained, we can't admit "capitalized medicine" is bankrupting us just before it kills us.
24
From a NY state ER doc. The medical billing situation is incomprehensible.
In network, the insurance company pays us almost nothing, less than you would pay a handyman. In network rates make it impossible for an ER doc to pay back the $350,000 in loans and 12 years of education. On the other side of this, it is unconscionable for a doctor to overcharge patients in an emergency situation.
NY state has a good law to bring fairness to both sides of the equation. The NY law says we can go out of network to allow us a decent rate of pay, but we can only charge up to a max of 120% of the published reasonable, usual and customary charge. This ends up being a few hundred dollars for most ED patients.
We need to fix our broken health care system. It is a complete mess. The medicaid patients in the ER pay us $18 for comprehensive care, then we have to pay the billing service $8, leaving us with $10 for the doc. The medicare patients pay us better, but barely cover the costs. The uninsured pay us nothing, and although federal law requires us to bill everyone using the same practices, we do not report any nonpayment to credit agencies.
We take care of everyone, regardless of their insurance, regardless of the time of day or night. Somewhere the system has to cover the cost of the physicians, along with the skilled emergency nurses, the radiology technicians, and the rest of the support staff.
In network, the insurance company pays us almost nothing, less than you would pay a handyman. In network rates make it impossible for an ER doc to pay back the $350,000 in loans and 12 years of education. On the other side of this, it is unconscionable for a doctor to overcharge patients in an emergency situation.
NY state has a good law to bring fairness to both sides of the equation. The NY law says we can go out of network to allow us a decent rate of pay, but we can only charge up to a max of 120% of the published reasonable, usual and customary charge. This ends up being a few hundred dollars for most ED patients.
We need to fix our broken health care system. It is a complete mess. The medicaid patients in the ER pay us $18 for comprehensive care, then we have to pay the billing service $8, leaving us with $10 for the doc. The medicare patients pay us better, but barely cover the costs. The uninsured pay us nothing, and although federal law requires us to bill everyone using the same practices, we do not report any nonpayment to credit agencies.
We take care of everyone, regardless of their insurance, regardless of the time of day or night. Somewhere the system has to cover the cost of the physicians, along with the skilled emergency nurses, the radiology technicians, and the rest of the support staff.
28
My primary dr recently told me to have a procedure done. Having a high-deductible plan and trying to be a “good consumer” I called my insurance co. and asked for a list of providers and what their charge would be. I was told that this information was confidential between the doctor and my insurance co. They suggested I call around. My first call resulted in a range of “between $500 and $4500.” It ended up being somewhere in the middle, all of it out-of-pocket. I dread medical care for my family knowing that I basically have to cross my fingers and hope that I don’t get robbed.
14
I'm sure Scalise had a choice about which air-ambulance, ER doctors, Hospital he wanted, making sure he go no out of network care when he was shot. I guess it doesn't matter - the tax payer will get all the bills regardless.
12
I use a non-profit HMO and have been very satisfied with it overall. I have heard many people complain about it, feeling like they have to press to get proper treatment. I feel that if anything, the inclination to wait-and-see can make the treatment safer, less expensive, and more convenient. The focus of health care should be on prevention and best practices, and not on what enriches the providers. I notice the difference in approach most often at the dentist, which takes a different insurance plan which pays a percentage of each treatment. I'm always suspicious that the dentists, who have to pay for their office space, staff, etc., have an incentive to recommend unnecessary treatment. The HMO doctors may be pressured by management to keep costs at bay, but that pressure may not be internalized in the same way when the doctor is on salary, and I feel more comfortable with a doctor who is more interested in treating patients than billing them.
"Insurers and health care providers typically sign contracts forbidding them to reveal the prices they have agreed to"
Time for that to be made illegal. If we can't have collective bargaining on pricing, then at least we need to see how the sausage is made and how "usual and customary" prices are nonsense.
Time for that to be made illegal. If we can't have collective bargaining on pricing, then at least we need to see how the sausage is made and how "usual and customary" prices are nonsense.
13
The major beneficiaries of this crime are everyone whose 401k owns stock in Envision, so it might be a good idea to check our own portfolios carefully before we start complaining about anyone else. This is a clear consequence of for-profit medicine. Sadly, the greed involved may well be our own.
5
When I got an echocardiogram, my doctor never mentioned that the report would be sent to another doctor for review - her husband! That raised the bill by several hundred dollars beyond her original estimate. Fortunately, when I pointed this out, she quietly deleted the extra charge.
Single payer.
Single payer.
18
Why did you let her get away with deleting it 'quietly'? Do you mean she didn't even say Oh gosh that was my mistake? or not even, I do apologise for trying to get more money from you than I am charging you already, because I am greedy and because we all do this to our stupid patients who are stuck with this?
Where is the rage we need to show them? yes, see below Mr. Goldsmith has the word ' FRAUD'. The next word should be SUE!
Where is the rage we need to show them? yes, see below Mr. Goldsmith has the word ' FRAUD'. The next word should be SUE!
3
There's an technical medical term for this. FRAUD!
20
Why is it acceptable that people in need of medical attention must also be experts in insurance matters - including understanding networks, billing, loopholes, what to say and what to sign in an emergency situation? How in the world does it make sense to ADD stress to people going to the emergency room in the form of fear of the bill that may or may not arrive? This is not remotely civilized. How much more evidence do we need for single-payer, or at least a public option?
26
Why isn't congress looking at this instead of playing insurance coverage games? This is one of the reasons healthcare costs are so high. Until we address the root cause of high cost we will never fix it. All that is happening now is an attempt to shift the cost from the insurance companies to the patients. It is like rearranging the deck chairs on the Titanic.
13
I repeat: making a profit from other's ill health is a lose lose for everyone other than the bill generator (and the corporate guys that don't care about anything other than their earnings). This article proves that good care is not dependent on how much it costs to give that care.
7
I have made a point of calling emergency rooms near me (before an emergency arises) to ask if any of their doctors don’t accept my insurance (Medicare).
I was pleased to find that many hospital emergency rooms are subject to hospital-wide rules about insurance acceptance. In two of the large hospitals near me, for instance, all of the doctors are required to accept Medicare.
In some other hospitals there is no such rule.
Answers from independent emergency rooms varied. I had to be very persistent in some cases, but I did manage to get an answer from each of the ones I called.
If I ever need emergency treatment I might not have much choice about where I will end up, but at least I’ll know which places to try to avoid.
I plan to be equally persistent in advance about any anesthesiologist or radiologist in my future.
I was pleased to find that many hospital emergency rooms are subject to hospital-wide rules about insurance acceptance. In two of the large hospitals near me, for instance, all of the doctors are required to accept Medicare.
In some other hospitals there is no such rule.
Answers from independent emergency rooms varied. I had to be very persistent in some cases, but I did manage to get an answer from each of the ones I called.
If I ever need emergency treatment I might not have much choice about where I will end up, but at least I’ll know which places to try to avoid.
I plan to be equally persistent in advance about any anesthesiologist or radiologist in my future.
3
This article outlines just one more way Congress ignores bad practices in American healthcare, in favor of profiteering at the expense of the American people and that leads to Americans paying twice as much for health care as people in some of the other advanced countries. A solution as simple as requiring anyone working in an emergency room or the hospital accept the insurance accepted by the hospital itself and that that insurer accept responsibility to come to terms with all those giving care in that hospital could put an end to this thievery. Make insurers and providers the responsible parties in healthcare and this practice will be driven out.
9
Another sick example of a private corporation benefiting on the sufferings of the American people. The profit (better called theft and stealing) element has no part in our health care system.
I think the ERs should send all their bills to Trump and Kushner.
I think the ERs should send all their bills to Trump and Kushner.
18
When you read the words "publicly traded" with respect to a healthcare organization, hold onto your wallet. Shareholders and execs require steady and bountiful streams of cash. They will bleed you dry.
19
Isn't this "upcoding" and isn't it considered fraud? Throw the book at 'em!
9
Whether an ER group, a Radiology group, or any other group working in a hospital, it is a privilege to do so since the group has, what is essentially an annuity, of a revenue stream of every patient that needs one of their services. Hospitals should flex their muscles and tell these groups that they must participate in all of the plans that the hospital participants in. They should also have that requirement for all physicians that have hospital "privileges." It is a privilege to own a revenue stream; not a right.
11
Universal healthcare with single payer would solve this problem too!
14
This practice is so outrageous I want to just scream. And it ahppens to thousands of people everyday.
SINGLE PAYER NOW!!!!!!!!!
Where are our democratic leaders?
SINGLE PAYER NOW!!!!!!!!!
Where are our democratic leaders?
11
Let the free, free, free market decide !
Ahaha ha !
Ahaha ha !
7
This is illegal in New York State. Yet, my local hospital ER tried three times to run this by me. Each time I called, went through the routine and had the charges removed when I told the CSR I knew about the law and the State Insurance Commission. The excuse was always the same...and right from the script.
9
I hope you reported them to your state insurance commission.
4
This is sadly not a new phenomena, but I am pleased that it is out in the open. With my years of hospital pricing and coding experience, I have always been frustrated by these kinds of providers who bill whatever they want.
Medicare, while not perfect, is a reasonable benchmark for the price of services. I have argued for decades that if there was a law that provided that all health care prices were quoted in addition to their face price as also a relationship to the Medicare price, e.g. this MD service of $225 is 185% of the Medicare price, patients would be able to be more price-point aware. Providers would over time develop a reputation of being a high-cost provider through the simple process of being identified a consistently 300% or 400% or 900% of Medicare as opposed to those that are 175% or 140%.
Medicare, while not perfect, is a reasonable benchmark for the price of services. I have argued for decades that if there was a law that provided that all health care prices were quoted in addition to their face price as also a relationship to the Medicare price, e.g. this MD service of $225 is 185% of the Medicare price, patients would be able to be more price-point aware. Providers would over time develop a reputation of being a high-cost provider through the simple process of being identified a consistently 300% or 400% or 900% of Medicare as opposed to those that are 175% or 140%.
6
Hopefully Democrats will pick up the mantle and campaign for Medicaid (includes basic dental and vision) for everyone.
It is the only way our country can regain its general health for everyone and go forward.
The wealthy can still have their butlers and high-end hotel hospitals but the rest of us deserve decent, competent healthcare based upon being Americans. We need to join the rest of the civilized world where people count more than money.
It is the only way our country can regain its general health for everyone and go forward.
The wealthy can still have their butlers and high-end hotel hospitals but the rest of us deserve decent, competent healthcare based upon being Americans. We need to join the rest of the civilized world where people count more than money.
6
I received a large bill for the ER doctor's services and when I called the company they said that they had billed my insurance company who had not paid. Therefore I was responsible for the total bill. I called my insurance company and they had no record of a bill for the ER doctor. I called the ER doctor's company and told them I would not be paying the bill until I had and EOB (evaluation of benefits statement) from my insurance company confirming that I was responsible for the entire amount. They repeated to me that they had billed my insurance and I owed the full amount. Interestingly,
within about two weeks I got an EOB from my insurance which showed they paid 80% of the bill and I owed only 20%. Then sure enough a new bill showed up from the ER doctor with the correct amount that I owed. They just
lied to me to try to get me to pay the entire bill, then I am sure they would bill the insurance company and they would end up with two payments on the same bill. This is a terrible way to manage ER billing.
within about two weeks I got an EOB from my insurance which showed they paid 80% of the bill and I owed only 20%. Then sure enough a new bill showed up from the ER doctor with the correct amount that I owed. They just
lied to me to try to get me to pay the entire bill, then I am sure they would bill the insurance company and they would end up with two payments on the same bill. This is a terrible way to manage ER billing.
16
With so many names listed in this article, why not this one:
Christopher A. Holden
Director, President and Chief Executive Officer
Envision Healthcare
6363 S. Fiddlers Green Circle, 14th Floor
Greenwood Village, CO 80111
Christopher A. Holden
Director, President and Chief Executive Officer
Envision Healthcare
6363 S. Fiddlers Green Circle, 14th Floor
Greenwood Village, CO 80111
23
To the New York Times and the three authors of this article: thank you. Stories like these are why you are the Paper of Record. Businesses, including hospitals, will try to get away with whatever they can. I'm a firm believer that sunshine is the best disinfectant. Shining a light on these shady medical billing practices will help put an end to them. It's absurd that a patient can go to an in-network hospital yet be billed for out-of-network rates. Upon admission, is the patient supposed to look at a roster of all the doctors so s/he can figure out which ones are in- and out-of-network and request treatment from only those in-network? For that matter, the concept of having in- and out-of-network hospitals at all is crazy. If you're in a bad car accident, the only priority should be getting you treatment, not which hospital has contracted with your insurer.
246
Agreed. in the interim, important to get to know the local Urgent Care. Utilize them to avoid a hospital trip, whenever possible. Also research local ambulance company/costs. And local hospitals to find out what their practices are, which ones take your insurance. These days we all have to be prepared.
1
Maybe as patients we should all carry a large card that reads " in an emergency, do not let out-of-network people talk to me tor touch me while I am being treated". Do you think that would alleviate our legal obligation to pay these outrageous bills? I was once held hostage at a hospital for 3 days so they could administer an expensive test. I was admitted into a room for 5 days but when the billing came it stated that I was not admitted and tried to charge me an awful lot more because of me being an outpatient. There were OON charges all over the place that time. Go figure.
1
For anyone who would like to contact EmCare and give them a piece of your mind, here is their contact info from their website:
EmCare Corporate Headquarters
EmCare Surgical Services Division
13737 Noel Road, Suite 1600
Dallas, TX 75240
800.362.2731 or 214.712.2000
EmCare Corporate Headquarters
EmCare Surgical Services Division
13737 Noel Road, Suite 1600
Dallas, TX 75240
800.362.2731 or 214.712.2000
11
Fee for service is the culprit, don't blame Obama for this. I have a good policy with Kaiser Permanente out here in California. Everything is covered. I appreciate this, as I have had cancer twice.
4
How did the U.S. become such a laughingstock -- a place where reliable medical care can't really be counted on anymore, unless you're willing to sign over the deed to your house? Everywhere you turn there are flat-out crooks in the system -- from obstructionist insurers whose only goal is not to pay, to companies like EmCare whose objective seems to be extortion of good people just when they're at their lowest.
We trail so many countries now in all the basics - wellness, healthcare, housing, educational costs, math, science, maternity leave . . . We've incentivized Big Food to sell their junk in easy reach while making fresh real food an ordeal to find and buy, particularly for kids and folks in poorer neighborhoods. A nation of obese laggards will never be strong.
And as education and opportunity have collapsed, a desperate populace too dumb to know better now elects "leaders" such as Donald Trump, a vindictive con artist whose childish windbaggery is aimed at undoing the few good things remaining in our society.
We are all stuck in this shameful, dispiriting nightmare within which extortionists such as EmCare are merely another repulsive player. Guess they fit right in.
We trail so many countries now in all the basics - wellness, healthcare, housing, educational costs, math, science, maternity leave . . . We've incentivized Big Food to sell their junk in easy reach while making fresh real food an ordeal to find and buy, particularly for kids and folks in poorer neighborhoods. A nation of obese laggards will never be strong.
And as education and opportunity have collapsed, a desperate populace too dumb to know better now elects "leaders" such as Donald Trump, a vindictive con artist whose childish windbaggery is aimed at undoing the few good things remaining in our society.
We are all stuck in this shameful, dispiriting nightmare within which extortionists such as EmCare are merely another repulsive player. Guess they fit right in.
14
One of the zillion reasons to go to a single payor system. If only Washington gave a damn about its constituents.
9
We are sheep to the slaughter-nevermind simple fleecing. The GOP is behind every wretched crooked thing in this country.
5
I guarantee you there is a power point presentation showing increase gross for the hospitals enrolled.
Who are they kidding?
Who are they kidding?
7
Well, since the ACA is so wonderful and handed Medicaid out like candy, what do you expect? Medicaid reimbursements are so pitiful that we have to make money somewhere. How? By gouging non-medicaid and non-medicare patients to cover the difference.
If we had a market system without the giant white elephant of government controlling such a large mass of patients/reimbursements, prices would drop to a reasonable level.
Oh, and if my ER were not flooded by never-paying illegals, things would be even better for hard-working Americans.
If we had a market system without the giant white elephant of government controlling such a large mass of patients/reimbursements, prices would drop to a reasonable level.
Oh, and if my ER were not flooded by never-paying illegals, things would be even better for hard-working Americans.
6
No, if we had a single-payer system and got rid of the giant white elephant of insurance companies (with their 5%-greater-than-Medicare-overhead) prices would drop to (at least) a more reasonable level.
4
j-dog: No, the government would then have a monopoly and there would be no competition. Moreover, good luck getting doctors to work hard that way.
1
"good luck getting doctors to work hard that way"
Working hard like billing $900 for "how are you today" ?
Monopoly works both ways, doc: where else are you going to work if the government has a monopoly? Canada or Mexico? Europe?
Working hard like billing $900 for "how are you today" ?
Monopoly works both ways, doc: where else are you going to work if the government has a monopoly? Canada or Mexico? Europe?
3
New York State has strict rules for emergency out of network surprise billing that protects the patient, the provider and the insurer.
================
http://www.dfs.ny.gov/consumer/hprotection.htm
================
http://www.dfs.ny.gov/consumer/hprotection.htm
4
Thanks! Very helpful link.
I do t understand that if I go to a
Participating hospital how is it that the ER or the anesthesiologist or the radiologist is not on my plan? If you work in that hospital you should accept the rates that the hospital accepts. That should be an easy ACA fix for those that care to address low hanging fruit
And, there should be a cost discussion prior to service
Participating hospital how is it that the ER or the anesthesiologist or the radiologist is not on my plan? If you work in that hospital you should accept the rates that the hospital accepts. That should be an easy ACA fix for those that care to address low hanging fruit
And, there should be a cost discussion prior to service
3
Yet another reason we need Medicare for all.
8
But even with Medicare, this can happen! It happened to me.
We need a govt-provided universal system system that has no room for fudging.
We need a govt-provided universal system system that has no room for fudging.
5
It's no longer enough for companies to make a fair profit on their services. These days it has to be an obscene amount.
7
Theives!
8
Note to patients: You do not need to pay outrageous medical bills. After you get the bill and call the billing office. Several options.
*You can tell the billing dept you cannot afford to pay the bill, but you could pay them $10 a month? or whatever you can afford that won't upset your life. The price of a few Starbucks a month should be doable; *you can raise holy hell all the way up the chain and make an offer that you can afford in order to release the bill; or *tell them you can't afford to pay anything. In this case, let the bill go to collections and negotiate with collectors. Sometimes, they will take pennies on the dollar. This is not perfect if you need to buy a home or car and care about your credit rating. However, today, many lenders will accept a lower credit rating if caused by an unfair medical bill.
Good luck.
*You can tell the billing dept you cannot afford to pay the bill, but you could pay them $10 a month? or whatever you can afford that won't upset your life. The price of a few Starbucks a month should be doable; *you can raise holy hell all the way up the chain and make an offer that you can afford in order to release the bill; or *tell them you can't afford to pay anything. In this case, let the bill go to collections and negotiate with collectors. Sometimes, they will take pennies on the dollar. This is not perfect if you need to buy a home or car and care about your credit rating. However, today, many lenders will accept a lower credit rating if caused by an unfair medical bill.
Good luck.
5
Medicare For ALL. PEROID.
18
With no room for loopholes!
3
The media should cease with their endless Russian hysterics and focus more stories on abuses of our healthcare system, jobs, opium addiction...things which matter!
5
While my comment goes against narrative that NYT tries to sell through its publications but this is the direct consequence of ACA.
The ACA with its intention of centralizing everything increased the regulations and made it so exorbitantly expensive and difficult for practices to survive that most had to close and go find a job somewhere.
Here is where national groups like Mednax, EmCare came in. This has led to direct corporatization of healthcare with no competition. If you go to any hospital you will find more people in black suits than white coats hanging in the corridors.
If we really are serious and want to deal with it reduce regulations and let physicians be physicians. Let the smaller practices come back, thrive and compete with these jerks and see how fast the prices start coming down.
Certainly that would mean acceptance from liberals as well that ACA was a very poorly drafted with a bad implementation piece of legislation crafted to boost ego of a president who did everything for his legacy.
The ACA with its intention of centralizing everything increased the regulations and made it so exorbitantly expensive and difficult for practices to survive that most had to close and go find a job somewhere.
Here is where national groups like Mednax, EmCare came in. This has led to direct corporatization of healthcare with no competition. If you go to any hospital you will find more people in black suits than white coats hanging in the corridors.
If we really are serious and want to deal with it reduce regulations and let physicians be physicians. Let the smaller practices come back, thrive and compete with these jerks and see how fast the prices start coming down.
Certainly that would mean acceptance from liberals as well that ACA was a very poorly drafted with a bad implementation piece of legislation crafted to boost ego of a president who did everything for his legacy.
3
This scam started long before ACA and is the direct result of treating medical care as a commodity and the greed of doctors who went into medicine for the money. Set that against the background of generalized greed and the "I've got mine" ethos that has pervaded the country since 1980 and you have the perfect political, economic, and social storm in which we now find ourselves.
2
"...this is the direct consequence of ACA...."
Nonsense. Speaking as a former senior medical director of a not-for-profit health plan I say that lying, cheating and effectively stealing by a combination of up-coding and/or overcharging are manifestations of sheer unbridled greed. ER docs were not much affected by ACA. There have always been wretched rapacious people in and around healthcare for the same reason that Willie Sutton robbed banks: it's where the money is, in addition to which the victims are in distress and had no choice about which provider serviced them. It's a thoroughly despicable Shkreli-like business which should lead to license revocations.
Nonsense. Speaking as a former senior medical director of a not-for-profit health plan I say that lying, cheating and effectively stealing by a combination of up-coding and/or overcharging are manifestations of sheer unbridled greed. ER docs were not much affected by ACA. There have always been wretched rapacious people in and around healthcare for the same reason that Willie Sutton robbed banks: it's where the money is, in addition to which the victims are in distress and had no choice about which provider serviced them. It's a thoroughly despicable Shkreli-like business which should lead to license revocations.
8
Come on NYT. How much money did these ER docs take home? It isn't reporting without fear or favor if you are too polite to ask.
1
The question you should be asking is how much these staffing companies take off the top before the ED docs and other providers are paid. The contracts for these staffing companies are not negotiated by the individual doctors. The people getting rich are not the doctors.
10
After reading this, I would think that upon entering an emergency room a good strategy would be to state right at the start: "If you are not a network provider, do not touch mez
5
Don't pay the bill! Often its the insurance company not recognizing the doctor,often they paid it but the Doctor wants the Ins discount which he is not entitled too.
Bottom line tell them you can't pay them and to ask Obama care to pay.
They are greedy crooks trying to rip you off
Bottom line tell them you can't pay them and to ask Obama care to pay.
They are greedy crooks trying to rip you off
4
I certainly hope that the Yale researchers didn't produce graphs showing such an uninformative jump from "???" to "100". On the other hand, I hope the NYT editors didn't either.
4
Great article
Thank you
Thank you
6
If EVERYONE had a high-deductible insurance plan as our family does, I think that this country would already have single-payer because when YOU pay the bills, you find out how greedy hospitals really are.
We had an incident this year where a radiology office owned by a local hospital charged us $1,900 for three foot x-rays. We have big-name insurance but when I called my insurance company, they said "that is the deal we made" with this particular hospital. For reference, a private radiology office down the hall from this office quoted $50 each for the same xrays. Our treatment was labeled "outpatient care" even though this office is 10 miles away from the hospital that apparently owns it.
It is beyond frustrating. You know that you are being cheated but there is nothing you can do, no one takes your calls, you just keep getting bills and eventually calls from a bill collector. I paid the bill to keep our sterling credit rating but felt as though I had been robbed at gunpoint. Now, we ask beforehand what THAT procedure costs with OUR insurance and just put up with the confused looks they give you when you ask.
Democrats could win with this issue alone. They must make single-payer their top priority and promise that they won't let their heads be turned by the lobbying money the medical community will try to throw at them. Their greed will be their undoing.
We had an incident this year where a radiology office owned by a local hospital charged us $1,900 for three foot x-rays. We have big-name insurance but when I called my insurance company, they said "that is the deal we made" with this particular hospital. For reference, a private radiology office down the hall from this office quoted $50 each for the same xrays. Our treatment was labeled "outpatient care" even though this office is 10 miles away from the hospital that apparently owns it.
It is beyond frustrating. You know that you are being cheated but there is nothing you can do, no one takes your calls, you just keep getting bills and eventually calls from a bill collector. I paid the bill to keep our sterling credit rating but felt as though I had been robbed at gunpoint. Now, we ask beforehand what THAT procedure costs with OUR insurance and just put up with the confused looks they give you when you ask.
Democrats could win with this issue alone. They must make single-payer their top priority and promise that they won't let their heads be turned by the lobbying money the medical community will try to throw at them. Their greed will be their undoing.
359
Similar thing happened to my daughter.
There is plenty you can do. Don't pay and start writing and complaining - Call your Dept. of Health and show them you are not a "sheep" Demand aanswers but definitely DON'T PAY.Let tthe get sick of you.
This is what Americans voted for. Small government and deregulation. Enjoy the surprise America.
7
My coworker with three kids, who pays the penalty rather than pay a 1k/mo. with a high deductible, goes to Tijuana for health care. Thanks Obama and Dems.
5
No its thanks to McConnell and the Republicans for not voting for a Medicare like system for all.
5
Well, good news for you then. Republicans control 2/3 of the states and the entire federal government, all three branches. Presumably you're just going to love what they come up with on healthcare. In fact, I would like to express my genuine, heartfelt wish that you and your loved ones to get to fully experience and enjoy the Republican healthcare you voted for.
2
My doctor charged me for the use of his office, which was in a hospital, for a Pap test. Then I got a bill from the hospital for the use of the doctor's office. I called Blue Cross about double billing and they actually laughed at me. I'll go to Planned Parenthood anytime rather than a hospital that has waterfalls, fountains and palm trees in their luxurious lobby. They only care about the almighty dollar
10
And what will you do when planned parenthood is defunded by the GOP?
2
"Insurers and health care providers typically sign contracts forbidding them to reveal the prices they have agreed to," Now can anybody enlighten me as to how a system based upon secret prices can in any way be called free market? When customers cannot find a price, and cannot choose due to immediacy it isn't a market, it is trough for a industry of gluttons to rape the public treasury.
19
Silly me! I always assumed that hospitals ran their own ERs. Turns out there's another company lodged there, another profit center. If I understand this article correctly, EmCare is calling most cases high-level emergencies, and individual doctors are walking around the ER, pretty much just enough to find out who the patients are, and then billing them. What I have learned: the ER is my enemy, a nest of fraud. And why would a sane person trust the medical judgment or performance of a bunch of con men?
10
You have a provider of healthcare (a physican) and a user of that healthcare ( a patient), put in the middle corporate groups like EMCare and insurance companies. Where do you think the money is going? Patients and physicians aren't the ones building multibillion dollar skyscrapers in every US city of any size. Those skyscrapers aren't going to build themselves. I am sure the patients must feel great relief during treatment, knowing just down the road, there is a billion dollar skyscraper full of billionaire CEOs making sure they get the best care America has to offer. How would the Doctor know what to do with out those billionaires? Healthcare and eldercare in America is a joke - if you don't know it now you will when you get there - and we all will one day.
6
How is this even legal. It's like you are going to a restaurant, order from the menu, and when the bill comes they tell you: Oh yeah, we have this out of state Chef working the kitchen today, so he charges 10 times the prices of our regular guys and you gotta pay that now, cause you ate it.
23
It is truly sad what has happened to this once great country. The American public has become a cash cow set up to be "milked" in almost every aspect of life. Sad, truly sad...
8
Hey, Democrats! This sounds like a perfect target for your "better deal" program.
Oh, wait. You're bought and sold by the healthcare lobby and your own care is covered by gold-plated insurance, thanks to the American taxpayer. Never mind.
Oh, wait. You're bought and sold by the healthcare lobby and your own care is covered by gold-plated insurance, thanks to the American taxpayer. Never mind.
1
It is the Republicans who do not want Medicare for all.
2
One major error in this article: EmCare's ER doctors (the ones that actually see and treat patients) are NOT in charge of billing. Their job is literally to see and treat patients; the doctors are essentially "employees" of EmCare. Coding and billing is a separate department run by EmCare. The whole point of ER doctors working for EmCare is so that they don't have to be responsible for billing. Please don't blame the hardworking, frontline ER doctors manning these short-staffed emergency departments for the billing issues of EmCare. That's like getting mad at your restaurant server for the high price of a food item that the restaurant owner decided to charge.
Among ER doctors, there's also another controversy. One where small democratic physician groups are being consolidated or taken over by large national staffing companies such as EmCare and TeamHealth... this is a topic in and of itself.
The point of this post is: the ER doctor that actually took care of you, is NOT the one sending you the bill.
SOURCE: I'm an ER doctor
Among ER doctors, there's also another controversy. One where small democratic physician groups are being consolidated or taken over by large national staffing companies such as EmCare and TeamHealth... this is a topic in and of itself.
The point of this post is: the ER doctor that actually took care of you, is NOT the one sending you the bill.
SOURCE: I'm an ER doctor
27
Well, this may or may not be the case. The doctors will note (often in terms of billing codes) what tests/procedures were done on the patient's treatment forms. The devil will be then in the details. If the back office can "exaggerate" the code used to be the top $ code within that procedures/test category, then they can (and may) do so, and the markup is the fault of the company. If however billing is done exactly according to the code the doctor enters for the patient (the back office system designed only to process the exact code the doctor enters), then the doctor is at fault. In these cases the doctor may be pressured by the company to do unnecessary tests and/or "inflate" the procedure code. Then BOTH are at fault.
3
"...short staffed emergency departments" which are the result of the contractor's staffing policy? Do we have a real shortage of ER doctors? I understand that many hospitals are dependent on foreign trained medical professionals who often have been educated and trained in countries where they do not have to pay huge sums to become qualified.
Corporate health care monitors the "productivity" of its employees and terminates those that don't generate enough billing. This involves all employees, not just MD's. Staffing for profit occurs at both nonprofits and for profit operations, extending from the front line staff into the back offices where billing coders follow policies given them.
If the care provider can reduce its costs by contracting out the function it will, adding another level of profit seeking behavior.
There are alternatives to single payer which achieve the same result. At one time Germany relied on highly regulated insurance companies, each of Canada's provinces had its own program. I am not aware of any voter uprising to change the systems that were in place and believe they have not changed. Their outcomes are better and cost less.
I am convinced that most of our problems can be traced back to a single cause: privately funded political campaigns which make legislators answerable to donors rather than the public.
Corporate health care monitors the "productivity" of its employees and terminates those that don't generate enough billing. This involves all employees, not just MD's. Staffing for profit occurs at both nonprofits and for profit operations, extending from the front line staff into the back offices where billing coders follow policies given them.
If the care provider can reduce its costs by contracting out the function it will, adding another level of profit seeking behavior.
There are alternatives to single payer which achieve the same result. At one time Germany relied on highly regulated insurance companies, each of Canada's provinces had its own program. I am not aware of any voter uprising to change the systems that were in place and believe they have not changed. Their outcomes are better and cost less.
I am convinced that most of our problems can be traced back to a single cause: privately funded political campaigns which make legislators answerable to donors rather than the public.
1
Yes, it's not the doc's fault and it bothers a lot of them as much as everyone else. Blame the profiteering companies and CEOs.
Single payer.
9
It should be illegal for any company or entity that provides healthcare--especially emergency room care--to have shareholders.
That is a conflict of interest from the word go.
That is a conflict of interest from the word go.
10
The CEO of Newport Hospital should be fired. That he was "caught off guard" by the deal with EmCare shows a unbelievable ignorance of industry billing practices. Just another example of why U.S. consumers pay much more for health care than consumers in other countries.
7
If only there were something Congress could do about this...
1
The profit motive must be stripped from health care, now. This absurdity must end.
7
Surprise billing is criminal. When you hear Republicans saying that their health bill "would let people negotiate coverage across state lines," what they really mean is that state laws against surprise billing would be eliminated by Congressional fiat.
2
Let's not forget about the FOR-PROFIT INSURANCE COMPANIES (whose execs bring in multiple millions) and the mysterious billing code book that hospitals won't share with anyone. I, too, an insured individual, had two medical emergencies with a year and a half. In addition to having to meet my exorbitant deductible each time ($2,000) I was billed by countless physician groups, anesthesiologists and others who nickled and dimed me for another few thousand. And there's nothing I can do about it but pay them off. It's disgusting.
5
One of these days we need to admit that "capitolism" has a role in many parts of our economy but not in the provision of health care. There was a recent multi center multinational study of stenting vs cabg of left main coronary lesions in the NEJM. Hidden in the appendix was a startling fact: the average cost of the entire hospitalization world-wide was $10,000. Geez you can hardly get a toenail removed in the USA FOR THAT. And of course there were absolutely no increased survival benefit seen in any one location.
Make America great again: behave like the rest of the world.
Make America great again: behave like the rest of the world.
4
Wonder why the US economy's growth is so slow?
In the 1960s, healthcare took about 4% of the GDP.
Today, it takes almost 5-times that.
Plus all the wasted time/effort for nonsense like these scams.
What a waste of effort - almost designed to slow the economy.
In the 1960s, healthcare took about 4% of the GDP.
Today, it takes almost 5-times that.
Plus all the wasted time/effort for nonsense like these scams.
What a waste of effort - almost designed to slow the economy.
4
It's pretty obvious that the ER doctors or at least the company that employs them are gaming the system for undeserved profit. The next time I'm in the ER with a broken leg bone sticking through the skin I'll make sure to ask for an estimate and whether or not the doctor is in or out of service.
4
EJS,
The doctors are salaried employees and are not in way associated with billing. Doctors have no idea what insurance companies are covered in the ER. It's not their job to do that. They are there to service their patients. The executives at EmCare and their billing department are the people ripping you off not the docs.
The doctors are salaried employees and are not in way associated with billing. Doctors have no idea what insurance companies are covered in the ER. It's not their job to do that. They are there to service their patients. The executives at EmCare and their billing department are the people ripping you off not the docs.
8
They are complicit if they filling out the forms sent to the billing department.
1
There is only one way to deal with this. When you get a bill -- balance bill after the insurance company is ripped off by the health care provider -- and you feel it is unfair and excessive: REFUSE TO PAY. Just negotiate it down to zero and let them threaten to put you in collection. I just got a steroid shot in my shoulder and the bill was $2,200, My share is $464. This took all of 20 minutes. Not paying it. You know what really got me? It was done in an examining room in a hospital, and the itemization included "operating room charge." The only way this will end is if we put up resistance. Good luck with hoping for single payer. Never happen. Big Pharma, medical tech, and the hospitals own the politicians.
4
Sounds good to me, hey, its the magic of the free market. You are writhing in pain in the ER, so some guy comes over and looks you over for a couple of $1000 bucks. And no one is responsible for it but you!!
If you dont like it, just get up and leave. Thats what Ayn Rand taught the GOP.
If you dont like it, just get up and leave. Thats what Ayn Rand taught the GOP.
2
This is why we need Universal Healthcare. We need to take the profit out of health care. Doctors and nurses need to be paid fairly, but no one at the top should make a fortune off of us. Definitely not insurance companies, share holders, and Big Pharma. We either trust our government to run a fair, efficient system, or keep it as is, where people at the top are making out like bandits, taking our money at our most miserable time of our lives.
Greed in health care is morally corrupt.
Greed in health care is morally corrupt.
6
This is what Congress needs to address as part of it's health plan.
The article is a little misleading in that physicians themselves would not be involved in billing although they could be involved in ordering unnecessary tests etc. The phycicians would be employed on salary (with a possible bonus) and the corp would clear whatever they billed minus what they paid the docs.
1
Does this sound anything like free-market capitalism, to anybody?
All of this nonsense vanishes under single-payer healthcare.
All of this nonsense vanishes under single-payer healthcare.
2
This sounds a bit like what Martin Shkreli pulled which was sleazy but legal. It’s possible that what EmCare is doing is both sleazy and illegal.
If so, it would seem appropriate to see the company in court and executives in jail to discourage other scoundrels from taking advantage of individuals in need of emergency care (and bilking insurance companies).
If so, it would seem appropriate to see the company in court and executives in jail to discourage other scoundrels from taking advantage of individuals in need of emergency care (and bilking insurance companies).
Numbers don't lie--these guys are crooks. Shame on them for violating their "do no harm"oath. They are harming their patients with unncecssarily high bills. And shame on Medicare (the biggest payer) for not figuring this out further harming all of us tax payers. Bravo, Yale.
3
Our medical insurance crisis came when insurance companies got involved...to the point that the average person has no idea what is going on. I personally have had to sit in the admittance and ask how much...the response is amazing from why would you ask to it's none of your business. Go ahead ask a doctor in an emergency room how much will this cost.
3
The right keeps harping about fraud running up health care costs.
Well boys, here it is.
Well boys, here it is.
I'm quite sure that fawn has NO health insurance.
2
Where are the Republican Congress and Trump now?
Time to investigate and publicize yet another group of corrupt health bureaucrats and officers. Shame and indict, then spit them out of the system.
Just one of the many corporations cashing in with our de facto criminal health care system..
1
Here's the problem with healthcare in the US:
http://www.startribune.com/unitedhealth-group-second-quarter-earnings-su...
http://www.startribune.com/unitedhealth-group-second-quarter-earnings-su...
Way to shine a light on bad behavior, NY Times. I too once experienced ambush billing from an ER, and it was infuriating. Keep up the good work.
3
I encountered an EmCare physician during an emergency room visit several years ago. I was charged $1,900 for its doctor to stand about 5 feet away from me, glance briefly at my chart, tell me I would be OK, and leave. About 15 seconds, total. That's $7,600 a minute, or $456,000 an hour for a doctor to do nothing for a severe nose bleed. (The hospital staff did nothing either. I got the bleeding to stop on my own by pinching my nose for an hour with a towel. But the hospital did charge me $50 for the towel, which they could buy at Target for less than $2.)
274
Then why are you going to an ER for a nose bleed?
9
Police officers are being called on to wear body camera's to record interactions with the people they serve to insure they are providing appropriate policing practices.
Maybe this is what we need for physicians from for-profit contractor companies charging $1,900 drive byes.
Maybe this is what we need for physicians from for-profit contractor companies charging $1,900 drive byes.
1
Maybe you should have tried to stop the bleeding at home before rushing to the most expensive possible place to receive medical care.
1
Another (mal)practice to investigate is unsolicited "specialist" visits that have nothing to do with treatment. I was in the hospital for colon surgery, and I had disclosed a past problem with alcohol as part of the check in questioning. Post surgery I was recuperating when I was visited by a psychiatrist asking if I needed help with my alcoholism, and I said no (I had been sober for several months by then). I later received a $200 bill from this (out-of-network) doctor, who had spent maybe 2 minutes in my room and left when I said I didn't need any alcohol-related assistance. Who know how much of this kind of subtle ambulance-chasing goes on? Please investigate as well!
233
Does anyone honestly believe that this company (EMCare) didn't know exactly what they were doing (not being in network) when they started these contracts with hospitals? They sensed a lucrative business opportunity and capitalized on it. A quick fix for this problem is that any doctor performing services at a given hospital (whether an employee of that hospital or not) must accept the insurance payments that were negotiated by that hospital. What does a patient in a hospital have to do, ask every doctor that pops into a room to see them if they accept that patients insurance? As others have said, single payer system!
278
It's absolutely their strategy to do that.
First EmCare claims that insurance payments are too low, then claim that they are attempting to participate with insurance companies. That seems suspicious. They could just as easily accept the network rate from the beginning, but there is more profit in their current business model.
I want to know who the ULTIMATE OWNER of EMCare is.
I will bet it is some private equity fund. They always have the slimiest practices.
I will bet it is some private equity fund. They always have the slimiest practices.
As an orthopedic practicing physician I see this all the time . What happens is the E.R. docs write out 4 or more pages of information on a simple fracture so they can bill at a higher level based on the # of Bullets in their note . All this information is useless. The whole billing system is corrupt and needs to be changed. My wife got a bill for $1360 for an E.R. physician visit when only seen for less than an hour. Ridiculous when I get reimbursed less than that for doing a total knee and following the patient for 3 months afterwards
295
Dr. Mull you're exactly right. All the notes in the world can't make a simple case into something more. A case of gastroenteritis in an otherwise healthy adult is no more than a level 3 ER visit:
"Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity."
Working in an elaborate past family and social history and a 12-system review of systems and exam doesn't alter the basics: the patient's got the trots and needs at most some basic labs and a prescription for an antidiarrheal and if dehydrated, some IV fluid.
It's not just EmCare that pulls this stunt; there are groups here in Mass. that do the same. It's a strategy by the PARE specialties (pathology, anesthesia, radiology, emergency) to avoid joining networks so they can bill as they please even if they don't actually upcode.
"Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity."
Working in an elaborate past family and social history and a 12-system review of systems and exam doesn't alter the basics: the patient's got the trots and needs at most some basic labs and a prescription for an antidiarrheal and if dehydrated, some IV fluid.
It's not just EmCare that pulls this stunt; there are groups here in Mass. that do the same. It's a strategy by the PARE specialties (pathology, anesthesia, radiology, emergency) to avoid joining networks so they can bill as they please even if they don't actually upcode.
3
Have you taken any action to escalate this issue to authorities that may have the power to investigate and address the issues ?
1
SML: where you are wrong is the assumption that you can just treat gastroenteritis. The patients don't come in with labels on them. You have to analyze their past history (diabetes? DKA), social history (alcohol? Pancreatitis) (tobacco? Esophageal cancer) (urban dwelling? Lead poisoning). Should you scan the abdomen? Is it a surgical case? And so on. That's where the complexity is. It's the analysis that you pay for, not just the treatment. That's why you will not have a gastroenteritis treatment being a level 3.
1
Patients do not know that they can complain and demand to pay a lower fee. As a biller and coder for over 20 years, I have learned a few tricks. Next time you get an out-of-network bill, call the physician and/or billing office and demand to pay the in-network rate. Obviously in an emergency, you are not going to call to check credentials, but if you are scheduled for a major operation, before you go in, call and make sure the surgeon and the anesthetist are in-network providers. Tell your surgeon you will refuse to pay for any non-network personnel. Americans are taken advantage of every day and do not have the knowledge to fight these fights. That is why we need single payer healthcare, not this disgusting piece of legislation the Republicans are trying to foist upon us.
539
"As a biller and coder for over 20 years, I have learned a few tricks."
You clearly understand this, but ordinary Americans shouldn't have to know "tricks" to avoid being fleeced, especially not when they're already vulnerable.
You clearly understand this, but ordinary Americans shouldn't have to know "tricks" to avoid being fleeced, especially not when they're already vulnerable.
3
Excellent advice. Usually one can find out directly if the surgeon is out of network by asking when referred--and not accepting a referral to someone not in network. But at least at our local hospital, the hospital assigns an anesthesiologist on the day of surgery. So the patient has no way of knowing if the anesthesiologist is in or out of network unless he/she asks at the time. And those bills are surprisingly high.
3
I am a physician, and I have tons of the system. This did not keep the anesthesiologist who gave me an epidural during my c section from trying to charge me 13k. luckily I live in MA now (this happened when I lived in NYC) and there are strong laws and I was able to block the charges!
3
This makes me so angry. Network, out of network--who flipping cares? It's legalized robbery, is what it is, and every doctor who submits one of these scandalous bills for out-of-network care, or allows such a bill to be prepared by others, should be forced to surrender his Mercedes and ride the bus so he can truly understand the consequences that these billing practices carry for the rest of the world.
There is simply no excuse. Just because you can do it doesn't mean that you should do it. Every physician who participates in this is part of the problem and should have "greed monger" printed on his office door. Physician, heal thyself.
There is simply no excuse. Just because you can do it doesn't mean that you should do it. Every physician who participates in this is part of the problem and should have "greed monger" printed on his office door. Physician, heal thyself.
420
I hear your frustration and sympathize with the burdens of increasingly expensive health care, but as an emergency medicine physician, please understand that the only reason I occasionally have to bill a patient directly is because your insurance company will not pay for the services due to the fact that I was not "in-network," which is simply their (arbitrary) definition of which providers and institutions you are "allowed" to receive care from if you want their help paying for your medical bills. This is a particularly ridiculous requirement if you are somewhere out of your home network and require emergency care. I have actually had patients leave the ER AMA because they knew that their insurance company wouldn't cover their bill. If you want to direct your anger anywhere, might I suggest the executives running insurance companies whose sole purpose is to maximize profits for their companies and investors at the expense of their paying customers and my patients through ever more prohibitive networks and higher premiums/deductibles. I am a human being with a family to care for and expenses to pay, so I will not deny that I need to make a profit from my work, but unlike the insurance companies, at the core of what I do is a desire to help people through a difficult and frightening time in their life.
I drive a 2011 Toyota Camry to work. If you want to throw eggs at a Mercedes, check the executive parking lot at your insurance company's headquarters.
I drive a 2011 Toyota Camry to work. If you want to throw eggs at a Mercedes, check the executive parking lot at your insurance company's headquarters.
7
JUST DON'T PAY MORE THAN THE OLD, USUAL FEE.
Actually, the physicians are employees of EmCare. EmCare determines what insurance networks to accept, does the billing, and presumably sets the policies under which the physicians operate to maximize revenue.
Corporations like EmCare, along with insurance companies and pharmaceutical benefit managers, are among the parasitic "greed mongers" whose proliferation the American medical-industrial complex encourages. They provide no health care for patients, and often serve to deny patients the care they need. But they divert billions of health care dollars to their executives and shareholders. The United States has a unique medical-industrial complex that creates enormous wealth for a privileged few, but fails far too many people. Wealth care is a higher priority than health care.
EmCare is among the most vile of those parasites, as it preys on patients who have no ability to shop for other providers, or to even know what their services will cost them until the surprise bill arrives. I have never heard of any "free market" in which buyers can neither choose sellers nor know the prices sellers chosen for them are charging. The medical-industrial complex is more like highway robbery than a "free market," and EmCare is a particularly brazen robber.
EmCare demonstrates the wisdom of every other civilized country that rejected "free market capitalism" for health care. How many Americans must suffer, die, or go bankrupt before we join the rest of the world?
Corporations like EmCare, along with insurance companies and pharmaceutical benefit managers, are among the parasitic "greed mongers" whose proliferation the American medical-industrial complex encourages. They provide no health care for patients, and often serve to deny patients the care they need. But they divert billions of health care dollars to their executives and shareholders. The United States has a unique medical-industrial complex that creates enormous wealth for a privileged few, but fails far too many people. Wealth care is a higher priority than health care.
EmCare is among the most vile of those parasites, as it preys on patients who have no ability to shop for other providers, or to even know what their services will cost them until the surprise bill arrives. I have never heard of any "free market" in which buyers can neither choose sellers nor know the prices sellers chosen for them are charging. The medical-industrial complex is more like highway robbery than a "free market," and EmCare is a particularly brazen robber.
EmCare demonstrates the wisdom of every other civilized country that rejected "free market capitalism" for health care. How many Americans must suffer, die, or go bankrupt before we join the rest of the world?
3
The hospital an hour's drive from Dallas where I was an RN in the ER for nearly 20 years brought EmCare in to provide physician staffing. Initially, it took in the existing docs and supplemented them with its own group of regional field supervisors and MDs who were essentially hired guns, who would work pretty much anywhere any time. ER staff noticed very quickly that the new guys approached ER medicine differently than the the crew of "old-timers."
CYA (use your imagination) lab test orders and superfluous x-rays became routine. One regional "troubleshooter" frequently completed his documentation of assessment, procedures, prescriptions and discharge before even seeing patients with minor illnesses and injuries. Another's quirk was to demand that every patient be stripped naked and in a hospital gown before he would enter the room, even if the complaint was a vision problem or a cut on the hand.
We knew most of our patients well. The ER doc was, after all, the closest thing many of them had to a primary care MD. Complaints rose, and not just for billing, but for several of the traveling EmCare physician's imperious attitudes. Nurses had many of the same issues with EmCare docs. One by one, our old crew of physicians moved away, partially because of the corporate pressure to overbill. Mostly to try to regain their autonomy.
The sense of "family" that existed among the nurses and doctors frayed. Work, once fun, no longer was. From what I'm told, it still is not.
CYA (use your imagination) lab test orders and superfluous x-rays became routine. One regional "troubleshooter" frequently completed his documentation of assessment, procedures, prescriptions and discharge before even seeing patients with minor illnesses and injuries. Another's quirk was to demand that every patient be stripped naked and in a hospital gown before he would enter the room, even if the complaint was a vision problem or a cut on the hand.
We knew most of our patients well. The ER doc was, after all, the closest thing many of them had to a primary care MD. Complaints rose, and not just for billing, but for several of the traveling EmCare physician's imperious attitudes. Nurses had many of the same issues with EmCare docs. One by one, our old crew of physicians moved away, partially because of the corporate pressure to overbill. Mostly to try to regain their autonomy.
The sense of "family" that existed among the nurses and doctors frayed. Work, once fun, no longer was. From what I'm told, it still is not.
375
In a free market, it makes sense to do whatever you want until you lose all your customers, and then adjust or go out of business. Because "freedom". That it's medicine makes no difference. That's why some people don't think a "free market" for health care makes sense.
2
This is exactly what happened in the HMA controlled hospital I formerly worked in Yakima Wa. I feel your pain.
2
Truly sad. The pox on our world is the financial industry. You can lead any problem we have back to that source.
1
It's not so hard. All private parties working under the umbrella of a hospital or clinic should be required to be paid salary only and under the control of the facility. Independent contractors have no place in healthcare! There should not be pay differentials for referenced care or difficulty of patient management, no bonuses - just care. It's not hard at all.
4
Mike,
There is an acute shortage of physicians in this country. You might not be seeing many docs if you refuse to use "locums" or "contractors" or temporary doctors. In our local hospital we have no "regular" oncologists now. The docs are all brought in from somewhere else. If not, we'd have to travel another hour further IF we can even get an appointment.
There is an acute shortage of physicians in this country. You might not be seeing many docs if you refuse to use "locums" or "contractors" or temporary doctors. In our local hospital we have no "regular" oncologists now. The docs are all brought in from somewhere else. If not, we'd have to travel another hour further IF we can even get an appointment.
1
American are all millionaires and can easily afford to pay for good service!! Why just look at what Comcast charges for TV, Internet and Telephone bundles....so why are you complaining about your health costs?
3
This is exactly what happened in the hospital I work in. The staff was told to go to in-network hospitals and they complied with that rule only to receive outrageous emergency doctor bills from the company that staffed the doctors who were out of network (on purpose of course). No where was there any information supplied warning the staff that the emergency room was staffed with out of network doctors. You assume when you are told to go only to an in-network ER, that the doctors are also in-network. Some of the staff flatly refused to pay the over inflated bills and some where sent to collections. Happily that fiasco ended when a bill preventing that practice in the emergency rooms in Florida was passed, but I know that I would think 10 times about going to an ER even if I desperately needed one to avoid being stuck with a huge bill, typically around 1500 dollars for a 2 minute visit by an emergency doctor. These are the sort of practices that endanger lives in the US.
5
So don't pay the illegal bills. If a collection agency goes after you, dispute the bill with a certified mail letter. Then the fraudulent biller will need to file a lawsuit to collect. See if they really want to go to court to defend fraudulent practices. Meanwhile, if in an emergency room, question every person who enters your room about their affiliation.
7
Just because you're out of network doesn't mean you have to bill at outrageous rates. These charges are hardly "usual and customary".
2
Yale Physicians are guilty of surprise billing. I can't believe they needed to study of someone else's practice when they could have just asked their patients in the New Haven area that they charge.
4
It's outrageous that the national conversation doesn't focus on why we spend twice as much per capita than virtually any other country but don't get the best care. The reason it's not part of the conversation is because no one wants to offend the deep, deep pockets that want us to continue to pay more than anyone else.
It's unconscionable.
It's unconscionable.
9
I am an ER physician who is responsible for negotiating contracts with insurance companies (aka,the devil incarnate). We are a single hospital ER group that is not part of any large staffing organization. I totally sympathize with patients who come to the ER or a hospital that is listed as "in network" only to have physicians who care for them be out of network. On the other hand,I have to
I am an ER doc in a suburb of LA and sympathize with patients who come to the ER or hospital thinking that if the hospital is "in network" then all the doctors must be as well. It is an unfair and untenable situation.
I am responsible for negotiating our reimbursement with insurance companies who will only minimally increase our reimbursement and have pointed out to them that their companies have made billions in profit and their CEO millions in salary and perks. I have been forced to go "out of network" with one company and am in the process of planning to do so with others. If a patient has already met his/her deductible,there is no additional cost to the patient and the insurance company must pay. However,most patients have high deductibles resulting in high out of pocket expenses. My solution is that any patient who has not met the deductible will have his charges reduced to the the "in network " rate. So far,no complaints. It's not a permanent solution but until the mess that the insurance companies have created gets resolved (I'm not holding my breath),it will have to do.
I am an ER doc in a suburb of LA and sympathize with patients who come to the ER or hospital thinking that if the hospital is "in network" then all the doctors must be as well. It is an unfair and untenable situation.
I am responsible for negotiating our reimbursement with insurance companies who will only minimally increase our reimbursement and have pointed out to them that their companies have made billions in profit and their CEO millions in salary and perks. I have been forced to go "out of network" with one company and am in the process of planning to do so with others. If a patient has already met his/her deductible,there is no additional cost to the patient and the insurance company must pay. However,most patients have high deductibles resulting in high out of pocket expenses. My solution is that any patient who has not met the deductible will have his charges reduced to the the "in network " rate. So far,no complaints. It's not a permanent solution but until the mess that the insurance companies have created gets resolved (I'm not holding my breath),it will have to do.
9
Look North, American friends: it's high time you adopt a universal, single-payer system, as in Canada (and most of the industrialized world). See https://en.wikipedia.org/wiki/List_of_countries_with_universal_health_care
This facet of American exceptionalism is beyond understanding. What is it with you folks?
This facet of American exceptionalism is beyond understanding. What is it with you folks?
14
Each Canadian pays in OVER ONE MILLION DOLLARS in their lifetime for their healthcare.
Single-payer is not accurate; every Canadian is paying into it to get what the govt decides is appropriate care.
Single-payer is not accurate; every Canadian is paying into it to get what the govt decides is appropriate care.
2
A million dollars over a lifetime is pretty cheap, considering that the average Canadian will earn well over ten million in the same period.
It's also disingenuous to imply that Canadians have only the public system. Most people working for large employers also have private insurance, and many forms of medical treatment are available on the open market. Overall, the system delivers better outcomes for a lower cost, and no one will be driven into bankruptcy because they can't pay for necessary care.
The U.S. system has some bright spots in terms of available treatements and professional expertise, but on the average it's inferior.
It's also disingenuous to imply that Canadians have only the public system. Most people working for large employers also have private insurance, and many forms of medical treatment are available on the open market. Overall, the system delivers better outcomes for a lower cost, and no one will be driven into bankruptcy because they can't pay for necessary care.
The U.S. system has some bright spots in terms of available treatements and professional expertise, but on the average it's inferior.
And how do you think Single Payer is going to work in the US? Canadians pay a lot of taxes for their care and EVERYONE pays into it, every one. Do you think it's going to be free here in the US?
1
If your doctor is employed or otherwise bound to a business group, either for-profit, or not for-profit, and usually with a legally binding non-compete agreement, this is the inevitable result.
Physicians will be forced to document and bill to the maximum, or be fired and forced out of their communities.
By comparison, even as a surgeon, I rarely bill to the highest level, even in the ER where I frequently consult. This is fraudulent until proven otherwise.
Physicians will be forced to document and bill to the maximum, or be fired and forced out of their communities.
By comparison, even as a surgeon, I rarely bill to the highest level, even in the ER where I frequently consult. This is fraudulent until proven otherwise.
5
This comment is on the money, with its observation about non-compete clauses. In most of the US, physicians are usually employees, and must sign onerous non-compete clauses if they wish to find a job. Under such clauses, physicians who are terminated from employment for whatever reason or who simply wish to change jobs must uproot their families and move to another city or usually another state. Thanks to these clauses, physicians have lost say in how hospitals are run, and in many circumstances cannot act as advocates for their patients.
State legislatures should pass legislation blocking the enforcement of non-compete clauses. It won't solve the entire problem documented in this article, but it will certainly help.
State legislatures should pass legislation blocking the enforcement of non-compete clauses. It won't solve the entire problem documented in this article, but it will certainly help.
3
I urge the NYT to do a similar analysis on Ambulance costs (particularly between hospitals). Twice I've been transferred from one hospital to another within 10 miles (because the first hospital did not do the procedures I needed), with the costs being $1,000 and $1,700, respectively, and treated as Out-of-Network so I had to pay the vast majority of it. The rides themselves were as comfortable as riding in the back of a pickup, with NO hookups or other medical attention needed. As best as I could tell they charged by-the-mile. $170/mile? Come on!!!
22
Just another example of why American-style predatory capitalism has no place in health care. Sadly, it's also an example of why a single-payer system is so unlikely here: Too many people accumulate wealth and political power in our current system.
13
Just one more reason why we need single payer universal health care.
10
Someone please tell me whose willing to make less money; nurses, doctors, insurance companies, healthcare systems, pharmaceutical? The ACA or any Republican ruse do little to address the real issue of rising healthcare costs. Both sides are too beholden to big healthcare to do any true reform.
5
The article says that California "recently" passed a law limiting out-of-network charges to patients, but it has been illegal since 2009 for ER docs-- or their billing companies-- to bill the patient for the excess over the amount that the patient's health plan will reimburse. So I do not understand how the practices described Crescent City, CA could have been legal.
4
I think you're talking about balance billing, where the hospital bills the patient for the full amount which is above the amount agreed up with the insurer. This article is talking about billings from out of network physicians, where the insurance company doesn't have an agreement with the billing doctor. The problem in this case is that the patient thinks the hospital is in network, which it is, but the hospital allows doctors who are not in the network to see patients.
Quite a sleazy practice.
Quite a sleazy practice.
4
California also forbids "non-competition agreements" for physicians, and has strict laws against "corporate practice of medicine".
Maybe some confusion here, because balance billing, by definition, occurs when the patient sees an out-of-network doc. The Crescent City incident looked to me like balance billing for ER care, but admittedly, the article is not specific on this point.
Please note that nurses, not just doctors, are increasingly being forced to chart in a way that augments billing.
This is fundamentally decreasing the quality of nursing care.
Nurses have a finite amount of time: more time for the charts means less time for the patients. Period. However, the reality of reimbursement means that hospitals must pay attention and capture as much revenue as possible.
For example, if I check a patient's blood sugar, the machine will automatically dock the result into the computer system. However, I am to manually also go into the system and note the 1) blood sugar result (increasing the chance for an entry error) 2) the reason the sugar was checked and 3) the machine number used. Meanwhile, I have less time to listen to your lungs, to notice a potentially dangerous medication interaction, or to advocate for you or your family member to receive nausea medication....i.e., to be a nurse. It seems like a small thing, but it is not as it is only one of many, many examples of the computer becoming prioritized over the patient.
We are discouraged from using free text to document our assessments and must use instead dozens of drop-down menus to describe, for example, a patient's abdominal pain. What this means for you is that call lights take longer to answer, or your medication may be ordered but not yet given, or your discharge paperwork may be up but everyone is so busy clicking they can't attend to you as quickly as they'd like.
This is fundamentally decreasing the quality of nursing care.
Nurses have a finite amount of time: more time for the charts means less time for the patients. Period. However, the reality of reimbursement means that hospitals must pay attention and capture as much revenue as possible.
For example, if I check a patient's blood sugar, the machine will automatically dock the result into the computer system. However, I am to manually also go into the system and note the 1) blood sugar result (increasing the chance for an entry error) 2) the reason the sugar was checked and 3) the machine number used. Meanwhile, I have less time to listen to your lungs, to notice a potentially dangerous medication interaction, or to advocate for you or your family member to receive nausea medication....i.e., to be a nurse. It seems like a small thing, but it is not as it is only one of many, many examples of the computer becoming prioritized over the patient.
We are discouraged from using free text to document our assessments and must use instead dozens of drop-down menus to describe, for example, a patient's abdominal pain. What this means for you is that call lights take longer to answer, or your medication may be ordered but not yet given, or your discharge paperwork may be up but everyone is so busy clicking they can't attend to you as quickly as they'd like.
41
Isn't it possible that in order to have viable ERs in undesirable areas you might need to pay a premium for medical care?
3
There are ways of dealing with underserved areas. Looking for potential medical school applicants who come from rural areas who want to live in those areas, scholarships for those students, and utilizing nurse practitioners and physician assistants are a start. A single payer health care system would help solve the issue as well. Why do insurance company and hospital staffing company shareholders need to make a profit on people's illnesses? Eliminating these middlemen would allow more money to go to the health care providers. Insurance company stocks are some of the fastest growing right now, and the shareholders are making money on all our medical problems. Does that seem right?
3
There are a lot of people getting rich off of health care, and this is the main reason why there is resistance to change. Physicians make up less than 10% of health care costs. While this article points out the billing of the ED group, one would have to ask, why is it that the insurance company says they are "out of network" in an emergent situation and refuses to cover the cost? Makes no sense. And why does a bag of normal saline cost $875 on average in an ED visit (basically salt water), but the bad guy is the physician who orders it and is charging the patient less than what the hospital is charging for that bag to costs? Don't let big business make physicians the scapegoat as to why health care costs are exorbitant. Have you asked how much the CEO of an insurance company or hospital makes lately? have you wondered why the tylenol you take over the counter or buy at Costco costs $400 when administered in a hospital for "nursing administration fees?" Health care is so broken in this country that it makes it difficult and hard at times to continue to care for patients. I agree there are a lot of people getting very very rich off of the sick, but it's not the physicians. Let's look at insurance companies, pharmaceuticals, and the cost of hospital "administration" if you want to go after the problem, rather than the providers (doctors, nurses, NP's, PA's) who were trained and are dedicated to taking care of the sick.
51
And Obamacare -- which was supposed to solve everything! -- actually entrenched this "for profit system" and made it worse, with the ACA which was WRITTEN BY AN INSURANCE COMPANY EXECUTIVE.
Obamacare made this "for profit insurance system" more powerful, more entrenched and impossible to get rid of.
Obamacare did NOTHING to control costs, but merely soaked the middle class to give 100% FREE Medicaid welfare to able bodied poor people.
THANKS OBAMA!
Obamacare made this "for profit insurance system" more powerful, more entrenched and impossible to get rid of.
Obamacare did NOTHING to control costs, but merely soaked the middle class to give 100% FREE Medicaid welfare to able bodied poor people.
THANKS OBAMA!
Not much different out here. With two major health care conglomerates supplying 80% of the services in a 4 state area, woe unto the person who has to go somewhere other than those 2 in an emergency or outside the area. The insurers work hand in glove with the conglomerates to soak every last dime in "out of network" expenses. Worse yet is when even your in network doctor has to refer you to a specialist out of network because the network doesn't have the specialist. It took 6 months to fight them all the way to court and "win" and the doctor was told to seek employment elsewhere, all for doing the correct thing for his patient. A pox on the health care rip off system. All the while, the state insurance commissioner who gets his donations from the conglomerates did absolutely nothing.
19
Continued greed and madness rule the medical care system. Single payer for all, one system, one card, better results all around.
21
2 things:
1) Why is this not front-page news? Forget Kushner. Forget the Russian issue (at least for 5 minutes). Health care is probably the most critical social issue facing Americans today. Many other things in the news are merely sideshows and distractions.
2) Only 163 comments on this article? Really? This article highlights some of the most egregious problems connected with the health care system in the U.S. and it seems that very few people are paying attention.
This does not bode well for long-term, positive reform of the system.
1) Why is this not front-page news? Forget Kushner. Forget the Russian issue (at least for 5 minutes). Health care is probably the most critical social issue facing Americans today. Many other things in the news are merely sideshows and distractions.
2) Only 163 comments on this article? Really? This article highlights some of the most egregious problems connected with the health care system in the U.S. and it seems that very few people are paying attention.
This does not bode well for long-term, positive reform of the system.
59
You are correct on both points. People don't pay attention to medical costs until there's a medical emergency followed by receipt of the bills. It's truly astounding. When you are laying on a gurney bleeding to death it just doesn't occur to you to ask the doctor whether she's in network or out. Why aren't state's attorneys' general looking in to bring fraud charges for this kind of thing?
2
Agreed. It is not headline news because Democrats and Republicans are 2 sides of the same coin destroying the country in their own special way...and the media carries the water for them.
3
A monster company, there is no other word to use to describe such a company.
17
I needed emergency treatment in France that involved two physicians (one a plastic surgeon), a number of tests, minor surgery with local anesthetic, and two follow-up visits. I didn't have insurance at the time, but since it was an emergency, my total out of pocket costs were $220. My care was excellent.
Compared to other countries, US healthcare is in the Dark Ages.
Compared to other countries, US healthcare is in the Dark Ages.
107
What is your citizenship? Confusing. If you are a US citizen, then that nice outcome is often reported. We have had similar low-cost, low-bureaucracy treatment in Germany.
I recently had an emergency room visit and admittance to Renown hospital. I am enrolled in a Medicare PPO with Humana Insurance. Just received a bill from Renown for $400 for various doctors. Called Humana and was told the doctors were "out of network". This is patently absurd. How is a person supposed to find an "in network" provider when he is laying in a hospital bed? I wonder if anybody has made that argument in court against an insurance company - patently absurd!
65
out-of-network surprise bills are not limited to the ER. My sister was in various intensive care units at a huge NYC hospital system as she gradually died of ovarian cancer, and after she died and well after she satisfied her insurance out-of-pocket expenses, the out-of - network bills started arriving, eventually totalling $14K. We fought them, and eventually settled for a lesser amount, but it was immensely complex and stressful. She used the hospital in part because it was in her network, and at no time were we notified that any of her doctors were not In network.
59
A similar thing happened to my mother. I swear any doctor would stick their head in the door and say "hey, how are you today?" and then a doctor's visit gets added to the bill.
162
before you let any physician near you, have to remember to ask that question - Are you in my network. It has to become routine for us.
6
The NYT reported a few years ago in an article on this same old same old topic, that it was normal for some docs to come into the hospital daily, look through the intake records; when they see a name they recognize as perhaps having been a patient, they go up to the room, open the door, and yes, hey how are you today, pause to enter this info into their diary for today, go back to their office and send an invoice to bill the client $1,700 ; in many cases the patient is asleep and is not awoken; many times they are comatose. Why are these doctors not sued for corruption? theft? illegal billing? Somebody - please! why can they get away with this? It is truly despicable. Is that what they teach in medical school??? I care because my kids live in the US and I am in terror for their health care.
Elizabeth Barry now in Toronto
Elizabeth Barry now in Toronto
183
I once was an inpatient at a New York hospital with pneumonia on top of my asthma and I was saddled with huge bill from a pulmonologist I didn't know. I paid the doctor what the insurance company paid and he agreed even though he wasn't happy about the reduction.
9
NY has dealt with this problem quite effectively. The insurer (who is required to pay for emergency services, even if out of network) is required to negotiate with the out of network doctor. If they cannot agree, the bill is submitted to baseball style arbitration. "Baseball style" means that the arbitrator cannot pick a middle ground figure. The arbitrator must choose either the insurer's amount or the doctor's amount. The result has been that we no longer have the insurer offering a ridiculously low amount and the doctor demanding a ridiculously high amount. Both are incentivized to be reasonable - so they don't lose the arbitration.
52
All another reason the US needs a single payer system. Price discrimination (charging patients different prices for the same service/good based on their insurance network) is illegal in nearly every other industry yet it is the cornerstone of the healthcare industry in the US.
A centralized, single payer system managing billing would be far more efficient and effective for patients, providers, and insurers - the status quo of every provider negotiating prices with every insurance company is unwieldy, inefficient, and ineffective. Providers should focus on care not billing codes, a single payer system would help enable care over coding and collection.
A centralized, single payer system managing billing would be far more efficient and effective for patients, providers, and insurers - the status quo of every provider negotiating prices with every insurance company is unwieldy, inefficient, and ineffective. Providers should focus on care not billing codes, a single payer system would help enable care over coding and collection.
51
It's called Medicare and it works beautifully, can hardly wait 5 years to enroll!
18
Good luck.
Where the patient is over charged, it is possible to get advice, for instance from the county society. The patient can then remit a reasonable amount, with a letter of explanation. The threat of collection practices and or of an effect on one's credit rating should not deter one from self-protection. No one goes to an emergency room to get fleeced and no company has the right to mistreat a patient or his/her wallet. To overcharges...just say "no"!!
17
Nice sentiments but "just say no" means months of intensive wrangling and negotiation by phone, letter, email, with your insurance the hospital etc. All while you are sick or newly recovered.
1
And we still hear that Obamacare is responsible for the rising cost and health insurance are the bad guys. It's amazing that the main players in the industry responsible for the outrageous cost from the hospitals are always forgotten from the media
25
Yes it is. In the wake of ACA, so many regulations (almost all unproven in any scientific study) were imposed that small practices couldn't survive. In came these kind of behemoths and physicians were forced to join them. It was infact encouraged in the name of uniformity by the previous administration. What it did was led to creation of these large corporations with no competition and what we see today is a result of this (look up your own health system and see who are the highest paid players.....I can tell you almost all are administrators). Other rich people in healthcare.....owners and board members of Cerner, Mednax, HCA, Allscripts, and a host of other regulatory companies.
and as for insurance companies....ask them why they won't publish their rates. Why is it a secret.
and as for insurance companies....ask them why they won't publish their rates. Why is it a secret.
When you enter an ER you are given a financial responsibility form to sign. Do as I do, and endorse the form with a statement such as "All providers must accept Medicare assignment. Patient refuses care from non-participating providers." Then date and initial the endorsement. (Substitute the name of your own insurer.)
Also state "Patient not responsible for uncovered services unless advised in advance that services might not be covered and has the choice to decline." Again, initial and date the endorsement.
You must at least try to protect yourself from greedy companies such as EM.
To
Also state "Patient not responsible for uncovered services unless advised in advance that services might not be covered and has the choice to decline." Again, initial and date the endorsement.
You must at least try to protect yourself from greedy companies such as EM.
To
96
Sounds great, but won't they just tell you to go elsewhere?
As the Times has reported, coding specialists are now a significant part of the healthcare economy, juicing bills (especially out-of-network) for profit.
Any real healthcare reform will need to address this. Other countries do so by having collectively-negotiated price controls. Sorry, coding people: it's time for your jobs to disappear.
Any real healthcare reform will need to address this. Other countries do so by having collectively-negotiated price controls. Sorry, coding people: it's time for your jobs to disappear.
19
Only in "exceptional" America are medical billing costs hidden from patients (consumers). The for-profit health care system in the U.S. is the world's most expensive by a very wide margin for this reason, but not with equally stellar results for patients. Quite the opposite, in fact. Republicans are responsible for this, and too many voters don't seem to comprehend the connection. But they will with morally bankrupt Republicans controlling congress and a president without a moral compass or empathy. A failing nation.
Eclectic Pragmatism — http://eclectic-pragmatist.tumblr.com/
Eclectic Pragmatist — https://medium.com/eclectic-pragmatism
Eclectic Pragmatism — http://eclectic-pragmatist.tumblr.com/
Eclectic Pragmatist — https://medium.com/eclectic-pragmatism
12
We spend much more than twice the amount per capita on health care than any other industrialized country.
11
The public seems incapable to following a cause-and-effect scenario. I give up, actually I gave up in November.
6
A true market would require price discovery and willingness to freely buy (or sell). Since that is impossible, any reference to healthcare as a market is meaningless. Republicans perpetuate "market solutions" when that is meaningless as Speaker Ryan's statements about "access" to care.
1
I recently had a hospital stay after an ER visit as well and a few months after I had paid the hospital bill, a doctor bill like the ones described in your article arrived. Thanks for the research; I'm going to challenge it with my insurance provider (through my employer) as they indicated that I've already met my deductible for the year. I'll use that and this article as leverage.
13
Stealing from sick, frightened people who come in via the ER is the foundation of the business model.
Sanders, Warren et al in 2020.
Sanders, Warren et al in 2020.
38
Sanders, Warner et al are part of problem not solution. This situation is created by the ACA that through all the regulations ran all the private practices to ground by making it exorbitantly expensive.
The void was filled by these guys like Mednax, Emcare etc. Now real the benefits while these guys and the owner of Cerner, HCA, Mednax and EmCare besides others who benefitted laugh their way to the bank.
The void was filled by these guys like Mednax, Emcare etc. Now real the benefits while these guys and the owner of Cerner, HCA, Mednax and EmCare besides others who benefitted laugh their way to the bank.
1
As a response to G, who thinks staffing companies like Emcare came about after ACA, read the article: Emcare started in the 1970's and this type of billing issue was a
Problem for years before Obamacare
Problem for years before Obamacare
5
This is frankly absurd. Short of single payer, it almost has me convinced we need price controls in the medical practice so that everyone pays the same regulated fee for the same procedure regardless of whether there has been a prior agreement with a patient's individual insurer (or whether the patient has insurance).
That won't ever happen of course, except maybe on a state by state basis.
That won't ever happen of course, except maybe on a state by state basis.
13
1
In my view, this clearly shows that a major component of the difficult situation regarding health care is the greed of the insurance companies. The though question is, though, how to tackle it.
6
This is the greed of the doctor companies.
1
"This is insane, and it's greedy."
Not to mention unconscionable, bordering on criminal. Also entirely predictable.
All of these descriptors apply to our current so-called system of health care, which is a system only in the same sense as Ponzi schemes and robbery plots are systems. Even when it's legal, it's appalling--all you have to do is look at any given doctor bill. If we spent half the time and money on providing care as we do on building Taj Mahal hospitals and advertising and coders/billers trained to squeeze every last drop from every turnip/patient, we might, just might, have quality of care akin to what folks enjoy in Scandinavia, Canada and other nations that long ago figured out that private-sector health care simply doesn't work. And at a fraction of the cost.
Medicare for everyone.
Not to mention unconscionable, bordering on criminal. Also entirely predictable.
All of these descriptors apply to our current so-called system of health care, which is a system only in the same sense as Ponzi schemes and robbery plots are systems. Even when it's legal, it's appalling--all you have to do is look at any given doctor bill. If we spent half the time and money on providing care as we do on building Taj Mahal hospitals and advertising and coders/billers trained to squeeze every last drop from every turnip/patient, we might, just might, have quality of care akin to what folks enjoy in Scandinavia, Canada and other nations that long ago figured out that private-sector health care simply doesn't work. And at a fraction of the cost.
Medicare for everyone.
30
FL proves that, if consumers collectively oppose a predatory healthcare practices, the state legislature will respond. If instead of sitting back and complaining, consumers banded together on other health-related issues, real change would happen.
5
Since single payer healthcare is probably years away with the Republican control of our government, let's hope this article is a shot across the bow of high medical costs. Thank you NYT. Having journalists expose these types of experiences of insured patients being blindsided is our only way to know something like this occurs.
13
A piece of the "why is health care so expensive?" puzzle. Keep the info coming, NYT...
19
This is not a new phenomenon. Ask me. I was just billed by a local urgent care 'system' for a lab procedure, outside of the pay up front fee I paid at the time of service, that they never appeared to have actually done, let alone completed. When I asked for them to send me a copy of the result so I could accurately asses that they did the test, they 'couldn't find it'.
The main problem with hiring these corporate shiester subcontracted billers which operate remotely is that they simply do not match the smaller scale of economic services these small town, rural hospitals operate under. It's not dissimilar to someone using a hammer to kill a fly. Hiring a high overhead, egregiously over paid urban corporation like "EmCare" to (over) bill farmers, laborers, should be considered a form of white collar crime. And, believe me, if we had a single payer system like every other civilized nation, 'EmCare' wouldn't exist.
The main problem with hiring these corporate shiester subcontracted billers which operate remotely is that they simply do not match the smaller scale of economic services these small town, rural hospitals operate under. It's not dissimilar to someone using a hammer to kill a fly. Hiring a high overhead, egregiously over paid urban corporation like "EmCare" to (over) bill farmers, laborers, should be considered a form of white collar crime. And, believe me, if we had a single payer system like every other civilized nation, 'EmCare' wouldn't exist.
26
Yet another reason we need Universal Healthcare!
22
The healthcare business sector spends enormous amounts of money (the most according to OpenSecrets) lobbying our legislators. If citizens only knew half of the inequities that are built into their costs, they'd be appalled. Glad to see NYT exposing some of them.
17
Republican Congressmen take note: that the prices negotiated by insurance companies and doctors are secret. How can the free market work with secret prices?
17
After one "ambush billing" experience of this nature I tried to be careful about checking whether all the ancillary practices associated with an inpatient elective surgical procedure would be in-network. My health insurer's website at the time had a disclaimer that said, more or less, it was not guaranteeing the accuracy of the information on the site as to who was in the network, because the status of any provider could change at any time. So much for trying to be a smart consumer.
31
In other words in America it's cheaper to drop dead or go without any treatment. There is pain at either end. Pain when it comes to the actual illness and pain when it comes to the "cost" which, considering the expense and how they go about collecting it, should be called a ransom.
13
What is the distinction between "inflated bills" and "egregious billing" and fraud and theft? To quote Woody Guthrie: "Some will rob you with a six-gun,
and some with a fountain pen."
and some with a fountain pen."
23
Until the US implements a single-payer health care system nationwide, this kind of thing will continue unabated. These private companies are like mosquitos, you swat one, a hundred others are waiting to take its place.
21
Yes, I actually asked my ER Dr. if he was in network when it appeared I may have suffered a stroke. Thank God I was cognizant. In the past I 'imagined' that if the hospital was in network, then the staff would be also. Wrong. On a previous visit I had a renowned cardiologist attend to me, and then also this other young woman who came in and asked me the same things my cardiologist did. I wasn't sure what her role was. I found out: she was there to ad the $800 to my portion bill, four times what I paid for the experienced cardiologist who actually did treat me. So yes please be sure you are not unconscious when you arrive at the ER and be sure and ask every single person who comes anywhere near you: "are you in network? " If not, then even if what sent you to the ER doesn't kill you, the bill, even with insurance, might.
62
Also, the picture of the rural hospital with the fawn in the corner is so perfect that it's almost hard to believe it wasn't staged. The photographer deserves a bonus. At least a pizza party.
21
Billing abuse. If McConnell actually wanted to do something about the complete failure of the current medical insurance regime, he would replace the entire medical billing system with something sane. He cannot touch the insurance companies because each of those are controlled at the state level. The insurance companies were very clever and avoided federal regulation a long time ago, but the billing departments could be federally regulated. Most of the collectors ought to be in jail. Right now the incentives for the billing companies to overcharge are so extreme they just can't help themselves.
The real point here is that as the boomers age they will need medical care and every company that can possibly get their hands into the dying boomers pockets and steal all of their money (so that the boomers' children don't inherit anything) are beginning to stick their hands out.
The GOP is not just failing to take action against the incredibly bad billing actors that are out there but in fact are facilitating the bad actors. Greed Over People party is an understatement.
The real point here is that as the boomers age they will need medical care and every company that can possibly get their hands into the dying boomers pockets and steal all of their money (so that the boomers' children don't inherit anything) are beginning to stick their hands out.
The GOP is not just failing to take action against the incredibly bad billing actors that are out there but in fact are facilitating the bad actors. Greed Over People party is an understatement.
17
Problem was created by dems with ACA and excessive CMS Regulations (mandatory EMR, meaningful use, MACRA, MIPS amongst many other unproven regulations) It drove small practices to ground and created these behemoths (like EmCare, Mednax). Any hospital corridor is teeming with people in black suits instead of in white coats all created to run the behemoths created to survive the regulations. Enjoy the benefits.
2
I was a victim of Emcare, worked for them for 5 years, I never new how much Emcare billed, and collected on my behalf, and my pay varied every month based on some mysterious calculation by Emcare. Finally my partners and I got sick and tired of Emcare, and gave the hospital an ultimatum, either us or Emcare. They chose us, and we have been in the same stable group for the last 10 years.
41
how did you get out of the non-compete clause in your contract?
3
the administration fired Emcare and paid them off to release the doctors [only 250K]
1
As a healthcare finance executive with 30+ years of experience (primarily on the medical group side) I'll point out something that I've not yet seen in the comments. Simply, the hospital that hires a physician staffing company like EmCare is not (or should not be) naive to the fact that, while they are contracted with the health plans operating in their market, EmCare will not be (nor is it incentivized to be). So, if you and the members of your community are victims of out of network billing take aim at the hospital administrators and Board members that brought an EmCare into your community, that is where the fault lies.
61
Yes the hospital board is not likely so innocent as the article implies. There is a never arms race between insurer and provider networks. A hospital may be able make a high profit with certain subspecialties (radiology) and loose money on others (psychiatry / pediatrics). They keep the loosing specialties on board in order to have the cache of being a full service hospital and because they can't keep residency programs going without certain core services. Hiring a physician staffing company is just the newest way to off load less profitable (at the in-network rate) areas. The patients are left in the lurch.
Its interesting but disheartening to see the liberals and conservatives give their take through their own myopic lenses. I think what gets missed is that the market isn't between the patients and doctors. Its between the insurance giants and the health care industry giants. Patients and doctor increasingly feel like road kill.
Its interesting but disheartening to see the liberals and conservatives give their take through their own myopic lenses. I think what gets missed is that the market isn't between the patients and doctors. Its between the insurance giants and the health care industry giants. Patients and doctor increasingly feel like road kill.
NY Times, you need to be doing another complementary investigation about how long it takes a doctor to get insurance companies to carry him/her at a new location/ hospital. First you have to get Medicare, which takes 3-4 months at least. Then, once you gave that, you have a pecking order of the ones that cascade down from that in your new hospital. To get all the insurers to allow you to bill them takes a year or more because of the red tape and slowness of the insurance company bureaucracies. It is monstrous the amount of time and effort to get approvals to join networks. There is a whole industry that charges an arm and a leg to do some (just some) of the paperwork for you. Then, every year, you have to do a whole new contract all over again with each one of dozens of insurers. (ER docs don't have staff to do it for them.) Check it out.
28
Wende Lewis, thank you for this information. I have long wondered how this works for any health care provider. You have, with your description, provided an interesting picture and one that adds more weight to the previous evidence of why we need a better medical care system. It's a shame that doctors and others undergo extensive training only to be sandbagged with requests and requirements that have nothing to do with patient care except the ability of health insurance companies to scam you and the patients. And at the end of all of it there's nothing good for the patient or the doctor unless you count getting an ulcer from the stress and we know who's helped by that.
12
Pieces of the "why is health care so expensive?" puzzle, July 24 edition: Part 1 is companies like Emcare. Part 2 is the length of time to get into the insurance system per this comment above.
2
If an ER is part of a hospital, the hospital should have their administrative staff complete this paperwork. The ER should not be a separate entity.
1
"She was shocked to get an additional bill from a doctor who she said never identified himself and only briefly touched her broken ankle. That physician worked for EmCare. Her portion of the bill is more than $500." Such incidents are outright fraud. If the feds paid as much attention to theft by doctors and hospitals as to kids sexting, it might put a small but measurable dent in the runaway cost problem.
20
Insane. No other part of the economy runs like this. It's like a Rubik's cube inside a jigsaw puzzle. As other commenters have written, single payor is the only solution.
22
Medicaid HMOs pays 23 -40 dollars in NJ for physician visit. For this you spend 10 minutes seeing and talking to patient and 30 minutes meeting all its unproven requirements. Only 30% of physicians accept it.
Problems all started when the small private practices ran into ground meeting all the government mandated requirements leading to creation of these behemoths.
No thanks. We are better off without more government. Rather we should remove regulations and let smaller practices thrive to compete with these behemoths. See how fast the prices will come down.
Problems all started when the small private practices ran into ground meeting all the government mandated requirements leading to creation of these behemoths.
No thanks. We are better off without more government. Rather we should remove regulations and let smaller practices thrive to compete with these behemoths. See how fast the prices will come down.
2
This issue of outsourced ER doctors not being "in network" even though practicing in hospitals that are in network has been documented for quite some time.
So with all due respect to the CEO of this hospital, if he did not address this issue when negotiating with EmCare, than he was negligent in his responsibilities.
So with all due respect to the CEO of this hospital, if he did not address this issue when negotiating with EmCare, than he was negligent in his responsibilities.
23
Glad to see this get a little press.
Both Liberals and conservatives have been so focused on access to and funding for healthcare that they've totally ignored the reason it has become such an urgent issue: rising cost. The research of Zach Cooper and his Yale colleagues has yielded some damning conclusions, and they're based on empirical evidence—not theories, predictions, or comparisons between different OECD healthcare systems.
They've demonstrated that there's absolutely no transparency for consumers, and the lack of scrutiny has allowed healthcare providers to jack up prices. One of their studies showed that the price of the same exact procedure will vary dramatically from hospital to hospital, even within the same metropolitan area, without any correlation with success rates. Because we're in the dark, we can't "shop around" other hospitals or ask our healthcare provider why their price is so different from other hospitals.
I mean, we get the bill for a procedure but there's no comprehensive, legible breakdown of the costs, and trying to get that info from your insurance or healthcare providers is impossible. How do you know you're not being charged $5 for a 4x4 gauze sponge?
You don't. You're meant to be in the dark. It's insane to me that consumer advocates on the left and free-market proponents on the right haven't joined forces on this when it seems like the one issue where their interests overlap. I wish the media would make a bigger deal out of it, too.
Both Liberals and conservatives have been so focused on access to and funding for healthcare that they've totally ignored the reason it has become such an urgent issue: rising cost. The research of Zach Cooper and his Yale colleagues has yielded some damning conclusions, and they're based on empirical evidence—not theories, predictions, or comparisons between different OECD healthcare systems.
They've demonstrated that there's absolutely no transparency for consumers, and the lack of scrutiny has allowed healthcare providers to jack up prices. One of their studies showed that the price of the same exact procedure will vary dramatically from hospital to hospital, even within the same metropolitan area, without any correlation with success rates. Because we're in the dark, we can't "shop around" other hospitals or ask our healthcare provider why their price is so different from other hospitals.
I mean, we get the bill for a procedure but there's no comprehensive, legible breakdown of the costs, and trying to get that info from your insurance or healthcare providers is impossible. How do you know you're not being charged $5 for a 4x4 gauze sponge?
You don't. You're meant to be in the dark. It's insane to me that consumer advocates on the left and free-market proponents on the right haven't joined forces on this when it seems like the one issue where their interests overlap. I wish the media would make a bigger deal out of it, too.
23
I'm waiting for Republicans in Congress to get off the backs of all those unmotivated, dependent Americans languishing on cushy welfare payments and go after the bigger pigs: the EmCares and the Health Insurance Companies, the crooked doctors and lawyers.
If Ryan could just raise his sights a bit he might realize that the hatred and condescension he projects onto everyone who takes advantage of the programs that saved his scrawny little teenager life, might better be directed at the real crooks, the real unproductive takers.
The scourge of the nation are these Real Good Americans, respected because they're rich and given a pass because they buy a Republican legislator every once in a while. Notably Ryan.
If Ryan could just raise his sights a bit he might realize that the hatred and condescension he projects onto everyone who takes advantage of the programs that saved his scrawny little teenager life, might better be directed at the real crooks, the real unproductive takers.
The scourge of the nation are these Real Good Americans, respected because they're rich and given a pass because they buy a Republican legislator every once in a while. Notably Ryan.
13
Ryan's life was not "saved" by his SS Survivor benefits -- it's only a few hundred dollars a month -- the Ryan's were wealthy and his late father left a big insurance policy. But EVERYONE gets SS Survivor benefits if the family breadwinner dies -- it is not means tested. So the wealthy Ryan family got the same benefit as anybody -- a welfare mother, Bill Gates -- anyone.
The benefit went to Ryan's MOTHER -- not Ryan himself, who was a minor child at the time his dad died. Ryan had NO SO-SO about collecting this benefit, and may not have even known about it, since he was a teenager.
His mother did not need to use the money to live on, so she banked it and used it for her kids college expenses. This seems pretty reasonable to me.
Whatever else you hate about Ryan....this is a stupid thing to harp on.
The benefit went to Ryan's MOTHER -- not Ryan himself, who was a minor child at the time his dad died. Ryan had NO SO-SO about collecting this benefit, and may not have even known about it, since he was a teenager.
His mother did not need to use the money to live on, so she banked it and used it for her kids college expenses. This seems pretty reasonable to me.
Whatever else you hate about Ryan....this is a stupid thing to harp on.
The small claims court system is rife with cases submitted by "out of network" health providers. Judgements in their favor are rubber stamped. Our taxpayer funded courts have become collection agencies for these shysters and the patient's credit is ruined in the process.
14
Wouldn't it be nice if our taxpayer funded courts tossed out these miserable claims and sent the EmCare's of the world home empty-handed. Where is their contract with the individuals being sued? No doubt, not transparent to the patient.
What EmCare is doing is criminal, but doctors are getting the lion's share of the money. Our system lets doctors get away with gigantic bills that bear no relation to their actual efforts. $500 to touch the woman's ankle? Oh, please. A dentist in my town has a "Super Yacht" magazine in his waiting room and was going to charge me $450 for a simple cleaning; talk about blatant greed! It's time for consumers to push back. A market-driven medical system doesn't work well because demand--the need for medical care--can't respond to price. You need help when you need it, regardless of how outrageous the price becomes.
13
please get your facts right. emcare docs are paid a salary that has little relationship to what corporate emcare collects
2
Unfettered capitalism at work. The only reason market-based national healthcare works in other countries--where there is profit for hospitals and physicians and drug companies--is fettered capitalism. The national government does what the US states are beginning to do -- set limits on what can be billed. Free markets, left unfettered, result in EmCare and the unlimited profits of healthcare delivery organizations. "Bending the cost curve" in healthcare means profit must be constrained. As it won't be done by the entities, as this article and study shows, it must be done by law.
8
What a mess...
Unfortunately, money is the universal incentive. No amount of regulation will change that. You can change the rules of the game, but you can't change the players.
Does anyone really believe switching to single-payer will magically erase the greed of doctors and hospitals?
Unfortunately, money is the universal incentive. No amount of regulation will change that. You can change the rules of the game, but you can't change the players.
Does anyone really believe switching to single-payer will magically erase the greed of doctors and hospitals?
2
As a retired Emergency Medicine physician let me point out three things:
1) Almost all physians who work for contract management groups such as Emcare are salaried so their incomes are not directly impacted by how much is billled in their name by these groups
2) Most board certified Emergency physicians would prefer not to work for large contract management groups and their shareholders but hospital administrators have chosen to contract with these middlemen and economies of scale for benefits including malpractice insurance leave the physicians little choice. I find the the quarter figure for Emergency Departments staffed by such groups hard too low and know that in South Jersey it approaches 100% other than the large teaching hospital, Cooper.
3) single payer or other forms of universal coverage would reduce bills as there wouldn't be large percentages of Emergency Department patients who pay nothing for the physician services they receive although before I retired NJ Medicaid hardly covered the per patient cost of malpractice insurance plus billing.
1) Almost all physians who work for contract management groups such as Emcare are salaried so their incomes are not directly impacted by how much is billled in their name by these groups
2) Most board certified Emergency physicians would prefer not to work for large contract management groups and their shareholders but hospital administrators have chosen to contract with these middlemen and economies of scale for benefits including malpractice insurance leave the physicians little choice. I find the the quarter figure for Emergency Departments staffed by such groups hard too low and know that in South Jersey it approaches 100% other than the large teaching hospital, Cooper.
3) single payer or other forms of universal coverage would reduce bills as there wouldn't be large percentages of Emergency Department patients who pay nothing for the physician services they receive although before I retired NJ Medicaid hardly covered the per patient cost of malpractice insurance plus billing.
15
US Health Care - a racket that the Mob would admire. How long this insanity can go on is anybody's guess.
9
I'm over 65 and on Medicare. Whenever I have to deal with a new physician or medical group, the first question I ask is whether they accept Medicare assignment, meaning that they accept Medicare's reimbursement as payment in full. If they don't, I keep looking. If they send me an ambush bill, I remind them that they represented themselves as accepting Medicare's rates.
The vultures in the medical business keep finding new schemes to increase revenue, often by circuitous and opaque means. This will not change until we rid ourselves of these parasites and institute universal, single-payer care. It's just ridiculous what we have to go through now.
The vultures in the medical business keep finding new schemes to increase revenue, often by circuitous and opaque means. This will not change until we rid ourselves of these parasites and institute universal, single-payer care. It's just ridiculous what we have to go through now.
18
Thank you, NYT, for outstanding reporting. I hope the next step is for EmCare to be investigated by the federal government, though the AG may be too busy being 'beleaguered.'
Who knew health care was so complicated? /sarcasm/
I truly believe the single most important step in making health care less complicated is to nationalize the entire thing, as the vast majority of developed nations have done. The U.S. is left behind in the dark ages (along with its arcane and non-secular attachment to creationism and not adopting the metric system, but that's a topic for another day).
Who knew health care was so complicated? /sarcasm/
I truly believe the single most important step in making health care less complicated is to nationalize the entire thing, as the vast majority of developed nations have done. The U.S. is left behind in the dark ages (along with its arcane and non-secular attachment to creationism and not adopting the metric system, but that's a topic for another day).
13
People being systematically bilked when they are at their most vulnerable. What kind of a nation have we become that we allow institutionalized price-gouging in the health sector? Appalling.
14
As a Canadian taxpayer who values his reasonably priced and effective taxpayer funded health care, I am continually shocked when I read of the greed, corruption and outright criminality in the U.S. system. But what is even more shocking is that your country seems incapable of cleaning it up!
If Americans once experienced what it is to have a decent healthcare system they would never give it up.
If Americans once experienced what it is to have a decent healthcare system they would never give it up.
14
Oh please give me a break. I'm also a Canadian as are my parents - born and raised. My parents have lived in Atlanta, GA part time for the last 20 years. I'm sick and tired of hearing about our "great" health care system in Canada. It's a lie. Reasonably priced? Yes and it's wonderful to go to the ER and not have to pay; however, if you have a serious illness you're far more likely to die in Canada because of ridiculous many-months (or year+) waits for sometimes important procedures. My parents have Kaiser Permanente (sp.?). When my mother's chronic leukemia became life threatening she was in the hospital for a blood transfusion and chemo within days. When she has blood tests her results are online the same day. The actual doctor or specialist will phone the house to see how things are, to explain results, and answer questions. When she needed knee surgery she waited 10 days. NONE of this would happen in Canada in fact it all sounds like science fiction to me. My mother's knee surgery would have been a two year wait in Canada. When my father was told of a cancer skin patch in Halifax, NS the procedure to treat it would have been more than a year. He had it done in under two weeks upon returning to ATL. And mother's CL? If she were in Canada she would have died I've no doubt. Our system is less expensive, but inferior to the American. Wait times are a *huge* issue that means loss of life for tens of thousands of Canadians each year and it goes unreported.
2
People need to start challenging outlandish medical bills aggressively. Just because someone sends you a bill of doesn't mean you are obligated to pay it. If you push back they will often back off. If they don't go to small claims court.
7
How can going to small claims court help you fight an erroneous bill? Sorry I'm not connecting the dots.
2
You can ask a small claims court to declare that the bill is invalid or to settle a controversy about the amount owed.
I live in Austin Texas. This article speaks to the problem that we have here. My wife gets insurance through her employer, a national healthcare company. She had to go to the ER several years ago, but as it turned out there ER doctors were out of network, so we got blasted for the bill there.
Earlier this year, I had to go to the ER. Having learned from our previous experience, we went to a different hospital, further away from us, and we still ran into the issue of the ER doctors not being in network.
We even changed insurance carriers last year in hopes of resolving the issue. But, as it turns out, in Austin Texas, the 11th largest city in the country, with a medical school at the university of Texas, and a plethora of hospitals all over the city, there is no hospital where both the ER services of the hospital and the ER doctors are covered by one insurance company. No matter what hospital we go to, we have to pay out of network for the ER hospital or the ER doctor.
Me thinks that there is a game being played here. Mr. McConnel and Mr. Cruz can shove their healthcare bills where the sun don't shine.
Earlier this year, I had to go to the ER. Having learned from our previous experience, we went to a different hospital, further away from us, and we still ran into the issue of the ER doctors not being in network.
We even changed insurance carriers last year in hopes of resolving the issue. But, as it turns out, in Austin Texas, the 11th largest city in the country, with a medical school at the university of Texas, and a plethora of hospitals all over the city, there is no hospital where both the ER services of the hospital and the ER doctors are covered by one insurance company. No matter what hospital we go to, we have to pay out of network for the ER hospital or the ER doctor.
Me thinks that there is a game being played here. Mr. McConnel and Mr. Cruz can shove their healthcare bills where the sun don't shine.
55
I now wonder if EmCare is involved in what happened to me. I went to the emergency room at St. David's in Austin. I gave them my insurance card, & within a month of being released, received a bill from one company, requesting payment of my deductible ($2000) for "emergency services." Began paying that off in installments.
Then three months later, a separate bill for "emergency services" from a different company arrived; this one demanding around $1500. They claimed that "Medicaid" had denied the claim. I wrote to them, asking exactly what this bill was for, & told them they should have submitted the bill to my insurer, not Medicaid! I sent the bill on to my insurer, & never heard a word back from the billing company.
Months later, they sent the same bill! Again, I wrote & forwarded the claim to my insurer. My insurer replied, saying that they wouldn't pay it because it had been submitted "too late." The billing company has never replied to any of my emails or letters. They have remained uncommunicative. I told them that I had already paid for "emergency services" at St. David's, & that they needed to specify exactly what they were charging me for. Silence from this company! I am expecting them to hit me with a collection notice, because these companies are leeches.
This is yet one more instance of the inefficiency of subcontracting out to private companies. They are accountable to no one & are utterly inaccessible & opaque.
Single payer NOW!
Then three months later, a separate bill for "emergency services" from a different company arrived; this one demanding around $1500. They claimed that "Medicaid" had denied the claim. I wrote to them, asking exactly what this bill was for, & told them they should have submitted the bill to my insurer, not Medicaid! I sent the bill on to my insurer, & never heard a word back from the billing company.
Months later, they sent the same bill! Again, I wrote & forwarded the claim to my insurer. My insurer replied, saying that they wouldn't pay it because it had been submitted "too late." The billing company has never replied to any of my emails or letters. They have remained uncommunicative. I told them that I had already paid for "emergency services" at St. David's, & that they needed to specify exactly what they were charging me for. Silence from this company! I am expecting them to hit me with a collection notice, because these companies are leeches.
This is yet one more instance of the inefficiency of subcontracting out to private companies. They are accountable to no one & are utterly inaccessible & opaque.
Single payer NOW!
19
The practice of hospitals hiring companies to provide doctors and nurses must stop. If you operate a hospital you need to hire your own staff. It is that simple. If you cannot find doctors and nurses to work for you, you have no business running a hospital.
I went to the ER last year. My insurance covered the visit after I paid my deductible. The doctor was 3rd party, a fact I did not know nor was I told (I was busy suffering from massive chest pains and didn't think to ask for his credentials, silly me!) His organization socked me with a huge bill that nearly gave me a heart attack on the spot!!
This has to end. It is highly unethical and unprofessional. Robbery. That's all it is.
I went to the ER last year. My insurance covered the visit after I paid my deductible. The doctor was 3rd party, a fact I did not know nor was I told (I was busy suffering from massive chest pains and didn't think to ask for his credentials, silly me!) His organization socked me with a huge bill that nearly gave me a heart attack on the spot!!
This has to end. It is highly unethical and unprofessional. Robbery. That's all it is.
15
I wonder if Yale's affiliated, EmCare-staffed hospitals were included in the study...
5
You should carry a card ATTACHED to your med insurance card saying you DO NOT CONSENT TO OUT OF NETWORK CARE. Better the risk than bankruptcy.
8
Phenomena like “ambush billing” put the lie to the free market dogma that we are all supposed to shop around for health care and be “smart health care consumers.” How can there be price transparency when the delivery of care is a tangle of contracts and you can’t even be sure who is actually providing care to you?
These practices have destroyed trust in the whole health care system. Anyone who has ever laid awake in a hospital bed has wondered if you’re there because you need to be, or if you’re just another cow being milked for billings.
These practices have destroyed trust in the whole health care system. Anyone who has ever laid awake in a hospital bed has wondered if you’re there because you need to be, or if you’re just another cow being milked for billings.
5
AN INSURANCE COMPANY That demands that patient information not be disclosed to patients is clearly in violation of the HIPAA laws. Any and all information in any patient's chart is the property of the patient. It does NOT belong to the medical provider. The patient authorizes the medical provider to retain medical information and to maintain its confidentiality. The idea of secret price gouging is infuriating. I hope that EmCare is investigated and shut down, its bosses and owners brought to trial for violating the HIPAA regulations and patients' rights. Who do they think they are inflating charges? Once again the 1% are exploiting and destroying the 99%, especially the middle class.
18
Following several visits to the surgeon's office, my late father was hospitalized for a couple of days prior to abdominal surgery. During that period a series of unknown physicians entered unannounced, engaged us in two minutes of perfunctory conversation, and vanished. None were part of the surgery team. None approached within four feet of the patient. Poring over the subsequent blizzard of bills I learned these brief extracurricular chats were billed at $500 - $600 a pop.
27
Yet another poignant example as to why we desperately need a single payer heath care system.
7
We continually blame administrative costs, management costs, external device maker companies as the main reasons health care costs are so high. The reality is that US physicians are as greedy as those in any other profession and demand high rates of pay that in other countries would not be tolerated. These companies that use out of network fees for physicians make huge profits but so do the physicians, themselves. We need caps on all fees related to health care costs and secondly a single payer system. A single payer system would eliminate at least 25% of fees because most of those 'backroom' workers we all see in hospitals and doctors' offices doing whatever it is that they do would be non existent.
10
EmCare said that it allowed hospitals to treat sicker patients when it takes over, and that an increase in such patients explained the higher billing in Newport.
**********
Emergency rooms at hospitals taken over by EmCare were turning patients away?
**********
Emergency rooms at hospitals taken over by EmCare were turning patients away?
8
No, the sicker patients were being transferred to larger hospitals. Inpatient facility fees are a revenue generator for hospitals. The ED is considered an outpatient environment, so emergency specialists often allow hospitals to keep patients that they might have otherwise needed to transfer out. For example, if you fall and have a broken rub/collapsed lung, an emergency physician could perform a tube thoracostomy (chest tube) to re-inflate the lung and you could subsequently stay at your small community hospital as an inpatient. In an ED staffed by non-specialists, you would be seen in the ED, but the doctor in the ED may not have the skills necessary to re-inflate the lung and you would hence be transferred to a tertiary care center for definitive care.
5
Another article pointing out the tremendous problems with American health care. No one wants to blame physicians, but they need to take the lead in a comprehensive overhaul of our system. Physicians have the most at stake as a profession, and know the system. Give physicians the complete tort reform (which means no lawsuits against physicians) they clamor for, then demand transparency in billing, and fees paid for patient outcomes, not merely for expensive procedures.
5
"But it acknowledged that surprise billing, as the billing is called when the doctor is unexpectedly not part of an insurance network...."
If we had a single payer system, LIKE ALL OTHER FIRST WORLD NATIONS ON THE FACE OF THIS EARTH, this would not be an issue. It wouldn't even come up.
If we had a single payer system, LIKE ALL OTHER FIRST WORLD NATIONS ON THE FACE OF THIS EARTH, this would not be an issue. It wouldn't even come up.
41
Only 3 nations in the world have single payer; none of them are in Europe.
I wish lefties who keep blurting out "single payer!" would actually bother to learn what it means. (Hint: it does NOT mean "everything is FREE!")
You can't possibly ever achieve reform -- or single payer -- if you don't know what it means, or mix it up with "universal health care".
Most nations don't use single payer; they use hybrid systems combining non-profit insurance with very basic government plans -- OR they have purely socialized medicine (like the British NHS) where government owns the hospitals and pays the doctors salaries. Neither of these are "single payer".
I wish lefties who keep blurting out "single payer!" would actually bother to learn what it means. (Hint: it does NOT mean "everything is FREE!")
You can't possibly ever achieve reform -- or single payer -- if you don't know what it means, or mix it up with "universal health care".
Most nations don't use single payer; they use hybrid systems combining non-profit insurance with very basic government plans -- OR they have purely socialized medicine (like the British NHS) where government owns the hospitals and pays the doctors salaries. Neither of these are "single payer".
Excellent story. Thanks NYT.
22
This is another reason why we need single payor universal access. Our fee for service wealth care system creates huge incentives to use the most complex codes so as to get the highest reimbursements possible even if the code is not the correct one in terms of how difficult the treatment is. When medical care is about money instead of about treating the patient and the patient is considered a consumer it's easy to charge as much as possible. It's simple for doctors, hospitals, and ER departments to assume that insurance will cover enough of the cost to make using the highest cost codes on bills. What they don't know or don't care about is how the refusals affect patients willingness to go for treatment for any condition.
If the wealth care industry is interested in creating a more healthy population they are going about it the wrong way. We will not be able to care for ourselves when we're viewed solely as pockets to pick instead of patients who need care. Just using myself as an example, I haven't used my asthma medication in about 3 years. I haven't been able to go to a doctor for that long. Why? Because of our Byzantine wealth care system that tends to the health of wealth care system rather than the health of patients.
Until patients needs and health are first, America will continue to have a very unhealthy health care system but an excellent wealth care system. And we can thank both parties for that.
If the wealth care industry is interested in creating a more healthy population they are going about it the wrong way. We will not be able to care for ourselves when we're viewed solely as pockets to pick instead of patients who need care. Just using myself as an example, I haven't used my asthma medication in about 3 years. I haven't been able to go to a doctor for that long. Why? Because of our Byzantine wealth care system that tends to the health of wealth care system rather than the health of patients.
Until patients needs and health are first, America will continue to have a very unhealthy health care system but an excellent wealth care system. And we can thank both parties for that.
22
hen3ry: if you are really doing as badly as you say -- unemployed -- why aren't you on Medicaid? You live in a state with generous Medicaid and health care policies. The ACA is still in effect. It doesn't make any sense!!! why suffer? are you a martyr? why live without necessary asthma medications? that's not even a super-expensive type of medication.
In my area, there are "free clinics" you could go to, even with no insurance or Medicaid -- heck, it would be better to see a doctor, get your meds and then refuse to pay the bill. Yes, your credit would take a hit but you'd STILL BE ALIVE. Asthma at your age is nothing to fool around with.
Will you have saved money when you end up hospitalized with pneumonia???
Trump has not been in office for 3 years. What was your excuse 6 months ago under Obama and Obamacare?
In my area, there are "free clinics" you could go to, even with no insurance or Medicaid -- heck, it would be better to see a doctor, get your meds and then refuse to pay the bill. Yes, your credit would take a hit but you'd STILL BE ALIVE. Asthma at your age is nothing to fool around with.
Will you have saved money when you end up hospitalized with pneumonia???
Trump has not been in office for 3 years. What was your excuse 6 months ago under Obama and Obamacare?
There should be a law that if a hospital or clinic is an in-network provider, that all bills, regardless of whether the physician or individual provider is themselves in-network or not, be processed as in-network. In all cases, the consumer does not have a choice of the person caring for them. You should not be in a vulnerable position and be forced to research the network status of a provider before allowing them to care for you.
33
When I retired, our group collected 36% of billing. I was an ER doc for 30 years. Most of billing was never collected.
The ER is a dumping ground, plain and simple. The all purpose answer for everyone on call.
This will not change without single payer, and tort reform.
The ER is a dumping ground, plain and simple. The all purpose answer for everyone on call.
This will not change without single payer, and tort reform.
25
I am still working, my group collects 20%
2
What is missing here is whether or not patient outcomes improved after the EmCare transition. Oftentimes community EDs are being staffed by non-specialists who are not residency trained board certified emergency physicians. EmCare employs only board certified EPs and that higher standard of care costs more. It is true that the average sprained ankle patient will have to pay more for having the facility staffed by a specialist and will probably receive the same level of care, but the hospital makes that decision so that patients having heart attacks, strokes, traumatic injuries, septic shock, crash deliveries, etc receive a higher level of care. We don't fund fire departments because they get kittens out of trees so well, we pay them 24/7 so that they are available when a real fire occurs. Family practice doctors staffing EDs do well a lot of the time, but the average family practice physician cannot perform key life saving procedures like thoracostomy, central line placement, endotracheal intubation, lateral canthotomy, etc that the emergency specialists do routinely. There is a lot more to this story than is being reported, we as a nation can have cheap emergency care if we want, but it will result in poorer outcomes.
5
I don't know but I doubt that a fire department sends the owners of the kitten a bill for $500 for getting it out of the tree. Fire department are still considered to be a necessary service for the good of all - and are therefore publicly funded. whereas hospitals and healthcare have become profit centers for shareholders and sleazy manipulators of a system that views patients as ATMs.
7
Totally agree. We should have a single-payer system and healthcare should be a service like fire, police, etc. As it stands now, healthcare is also largely publicly funded and insurers are an unnecessary middle man. My point was that the article glosses over the value added service that EmCare provides (more skilled physicians). It is the insurance companies that create and sustain this problem by keeping their networks so geographically tight that the vast majority of physician fees get billed as "out of network".
5
Show me one person who has ever gotten a surprise bill for having the fire dept save their house.
Emcare's practices are pure greed. Just like Martin Shkreli and the way he jacked up prices for long ago developed life saving medications.
Emcare's practices are pure greed. Just like Martin Shkreli and the way he jacked up prices for long ago developed life saving medications.
1
And why are people against single payer universal healthcare?
16
1. People who have good, employer health care are afraid of changing things. They need more information about what they have been paying for their health care in lost wages.
2. Many investors are making a killing investing in
Health on the market.
3. Our Govt civil servants are addicted to Health dollars gfowing into their campaign war chests.
2. Many investors are making a killing investing in
Health on the market.
3. Our Govt civil servants are addicted to Health dollars gfowing into their campaign war chests.
5
I'm not against it but I'm cautious. I'm 67 and still on my company HSA plan. I pay really high taxes as a single person, and I do not collect Medicare.
You do know how much your taxes would go up to pay for this? I need every penny I can get now to fund my retirement. I have painstakingly cared for my own health and finances and don't mooch off medicare yet. That means no soda pop, no cookies, no candy, no overeatijng, exercise everyday -- and yet I have to pay for your indulgences. and yes, I'm a Democrat.
Is it fair that my taxes go sky high? A single healthy 67 year old woman?
You do know how much your taxes would go up to pay for this? I need every penny I can get now to fund my retirement. I have painstakingly cared for my own health and finances and don't mooch off medicare yet. That means no soda pop, no cookies, no candy, no overeatijng, exercise everyday -- and yet I have to pay for your indulgences. and yes, I'm a Democrat.
Is it fair that my taxes go sky high? A single healthy 67 year old woman?
Leonora: it makes no sense to forgo Medicare -- for one thing, you pay a small penalty for every year you don't enroll.
With a high deductible HSA, you are in an ideal position to use Medicare for your basic expenses, and then add in the HSA for any non-covered or expense care -- things like dental, vision, hearing.
I am surprised that a highly educated attorney would not know this. Is it vanity that keeps you from enrolling in the Medicare you PAID FOR over the last 45 years?
BTW: it's good to stay healthy, but I'm pretty sure you deny yourself every pleasurable thing in life -- at 67! -- because of your vanity about being very slender, and not for "health". (This has a name: orthorexia.)
Here's a wakeup call: you can starve yourself and live like a monk, but you are going to get old and die anyways.
With a high deductible HSA, you are in an ideal position to use Medicare for your basic expenses, and then add in the HSA for any non-covered or expense care -- things like dental, vision, hearing.
I am surprised that a highly educated attorney would not know this. Is it vanity that keeps you from enrolling in the Medicare you PAID FOR over the last 45 years?
BTW: it's good to stay healthy, but I'm pretty sure you deny yourself every pleasurable thing in life -- at 67! -- because of your vanity about being very slender, and not for "health". (This has a name: orthorexia.)
Here's a wakeup call: you can starve yourself and live like a monk, but you are going to get old and die anyways.
Good study. This Ambush Billing needs to be outlawed. Think this will get better under Trump? Dream on!
13
No one ever wants to blame the doctors, but MDs are the primary beneficiaries of these systems, which are often founded and cooperatively owned by the physicians who work for them. Thus any increase in company profits is an increase in the MD's personal income.
22
Emergency Dept physicians are pretty well paid (lots of training, shortage of board cert. ER docs, tough job with high stress, etc.), but I wouldn't confuse that with benefitting from the billing practices of a large, publicly traded company. EmCare/Envision is not cooperatively owned by physicians. There are many ER physicians who do not like the large contract management approach; in fact, there's a whole physician membership group that is opposed to it (AAEM).
6
Patients do not realize that EmCare/Envision Healthcare Holdings is a "for profit" staffing business. What does for profit mean? It means they report earnings to stockholders.
In this case, EmCare staffs just the ER but many times radiologists, anesthesiologists or any shift work based physician job can be managed by EmCare. Sometimes even an entire hospital is part of a for profit system eg the Health One system here in Denver.
So why does a hospital need to hire an outside company for staffing purposes? It is often because the hospital itself has mismanaged staffing in the past or has failed to incentivize and adequately recruit for the job. Think about it- an ER needs to be staffed 24/7. What happens when a particularly undesirable shift goes uncovered (eg the night shift on New Years Eve)? Well the risk is that the shift goes uncovered and nothing changes the quality of patient care more than an understaffed hospital.
In this case, EmCare staffs just the ER but many times radiologists, anesthesiologists or any shift work based physician job can be managed by EmCare. Sometimes even an entire hospital is part of a for profit system eg the Health One system here in Denver.
So why does a hospital need to hire an outside company for staffing purposes? It is often because the hospital itself has mismanaged staffing in the past or has failed to incentivize and adequately recruit for the job. Think about it- an ER needs to be staffed 24/7. What happens when a particularly undesirable shift goes uncovered (eg the night shift on New Years Eve)? Well the risk is that the shift goes uncovered and nothing changes the quality of patient care more than an understaffed hospital.
3
The statistics showing fraudulent billing are compelling
Why are not this companies executives and its physician employees indicted for fraud?
Why are not this companies executives and its physician employees indicted for fraud?
20
I was once a victim of “ambush” billing even when I took deliberate steps to try to avoid it. I was injured in a bicycle crash but not so severely that I couldn’t call my insurer and verify that the hospital I was headed to was in network. I was assured it was.
Four weeks later I got a bill from a company I had never heard of. It was from the out-of-network radiology practice who x-rayed my shoulder at the in-network hospital. I complained to my insurer about the unexpected bill I got by relying on their advice. They seemed surprised that I was troubled by this but they eventually agreed to cover the expense. This happened to me 15 years ago. It's sad and troubling to hear it's now even worse.
Four weeks later I got a bill from a company I had never heard of. It was from the out-of-network radiology practice who x-rayed my shoulder at the in-network hospital. I complained to my insurer about the unexpected bill I got by relying on their advice. They seemed surprised that I was troubled by this but they eventually agreed to cover the expense. This happened to me 15 years ago. It's sad and troubling to hear it's now even worse.
36
To be fair, it's not really the insurer's fault. They contracted with the hospital and likely had no knowledge that the hospital employed out-of-network providers. That said, insurers should mandate in their contracts with hospitals that if the hospital is in-network, it cannot (nor can anyone working there) bill the patient for out-of-network services.
3
But in network docs may not be available or be on call in an emergency.
Why doesn't the free market function to reduce emergency room costs?
The free market requires that consumers have a choice. If there is only one emergency room nearby or you are mentally incapacitated, then there is no choice. The market fails. More generally, consumers are provided very little information about the price of services or the outcomes to be expected. The supplier holds all the cards in such a system.
The free market requires that consumers have a choice. If there is only one emergency room nearby or you are mentally incapacitated, then there is no choice. The market fails. More generally, consumers are provided very little information about the price of services or the outcomes to be expected. The supplier holds all the cards in such a system.
17
As a medical social worker I pride myself on assisting my families through the bureaucracies of this countries healthcare, but when my child was required to have 2 separate surgeries for hearing loss, my family was billed out of pocket for his anesthesiologist as she was "out of network". When it came to his second surgery, I personally called the anesthesiologist to assure that this would not happen again. I was assured it would not. But it did.
California has a new law that makes this type of billing illegal. More states most likely to follow.
California has a new law that makes this type of billing illegal. More states most likely to follow.
97
New York has a "surprise bill" law as well.
I had a similar experience. I went to a surgeon after checking he was covered by my insurance. He wasn't in the list on my company's website, but he assured me personally that he was, as did his staff. While I was home recovering, I got a check to pay him for $97,000 - against a bill for $147,000. The situation wasn't covered under the surprise bill law because I had an "ongoing relationship" with him. So I asked a friend who was an attorney to put the check in his escrow account and to send a letter saying that as soon as I got a bill accepting the money I had, they'd get it, but until then, it would sit in his escrow account. I also filed the surprise bill paperwork, which is how I found out this type of situation isn't covered. It took them less than two weeks to sign off on accepting the amount my insurance company paid, which I'm sure is exactly what any insurer's negotiated fee would have been.
Punch line: My insurance company is a US Healthcare company called The Empire Plan, aka United Empire. The surgeon accepted various other UH plans, just not THAT one.
If our government will not stand up to stampeding health care costs and procedures, then we have to do it ourselves. Until we get a sane and sentient government that allows us universal care.
I had a similar experience. I went to a surgeon after checking he was covered by my insurance. He wasn't in the list on my company's website, but he assured me personally that he was, as did his staff. While I was home recovering, I got a check to pay him for $97,000 - against a bill for $147,000. The situation wasn't covered under the surprise bill law because I had an "ongoing relationship" with him. So I asked a friend who was an attorney to put the check in his escrow account and to send a letter saying that as soon as I got a bill accepting the money I had, they'd get it, but until then, it would sit in his escrow account. I also filed the surprise bill paperwork, which is how I found out this type of situation isn't covered. It took them less than two weeks to sign off on accepting the amount my insurance company paid, which I'm sure is exactly what any insurer's negotiated fee would have been.
Punch line: My insurance company is a US Healthcare company called The Empire Plan, aka United Empire. The surgeon accepted various other UH plans, just not THAT one.
If our government will not stand up to stampeding health care costs and procedures, then we have to do it ourselves. Until we get a sane and sentient government that allows us universal care.
4
These companies usually split the coding and staffing components. The ER doctors just try to do their job, but get pushed to upcode everything (phone calls and emails during shifts even). I worked in a similar environment and moved on (not specifically EMCare). The real question is why do so many hospitals contract with such a company? Usually because they offer to reduce expenses for the hospital (lowest bidder). Then, lo and behold, patients get higher bills. The hospital saves money at first, and then finds out why (costs pushed to their patients). I do not feel sorry for these hospital administrators.
22
And the hospitals can also take the contract to a provider as a Cost--contacting services in the ER and anesthesiology doesn't just saves the hospital administrative time and personnel and hassles, it provides a nice tax write off. Patients cannot chose their ER doctors or anesthesiologist or radiologist -- they must have whoever is on rotation. That's why you see niche services in these particular specialties--no patient choice. Free market at work.
2
Heathcare service is like police service and firefighter service. It is there to protect Americans from harm to life and liberty and to empower them in their pursuit of happiness. It supports our declaration that all Americans are created equal.
Required Results of New Healthcare Act:
One: Expand the number of people covered.
Two: Do not reduce the benefits of any person now eligible.
Three: Do not increase the costs to any person now covered.
Four: Pre-existing conditions covered.
Five: U. S. Government to negotiate drug, device, and service prices.
Six: U.S. Government to allow purchasing drugs and devices from foreign sources.
Seven: Companies that drop participation are not allowed to have any U.S. Government business. https://www.theatlantic.com/health/archive/2017/05/why-so-many-insurers-...
Eight: Elected officials have the same coverage as ordinary Americans.
Nine: Preventive Life Style screenings with first visit of a calendar year
Ten: No restrictions of funding for Planned Parenthood
Eleven: Better policy on the disposition of “expired”, but still safe and effective drugs.
One approach would be Medicare/ Medicaid for all Americans.
Required Results of New Healthcare Act:
One: Expand the number of people covered.
Two: Do not reduce the benefits of any person now eligible.
Three: Do not increase the costs to any person now covered.
Four: Pre-existing conditions covered.
Five: U. S. Government to negotiate drug, device, and service prices.
Six: U.S. Government to allow purchasing drugs and devices from foreign sources.
Seven: Companies that drop participation are not allowed to have any U.S. Government business. https://www.theatlantic.com/health/archive/2017/05/why-so-many-insurers-...
Eight: Elected officials have the same coverage as ordinary Americans.
Nine: Preventive Life Style screenings with first visit of a calendar year
Ten: No restrictions of funding for Planned Parenthood
Eleven: Better policy on the disposition of “expired”, but still safe and effective drugs.
One approach would be Medicare/ Medicaid for all Americans.
16
This article is a very good illustration of why we need to go to a single-payer system. Under such a system there would no longer be "in network" and "out of network" nor would there be byzantine deals between insurers and providers. Charges and coverage would be transparent to all; no surprises.
62
I'm trying to understand. I go to the ER; at this point I have o choice but to sek medical attention. The clerk at the front desk tells me that the hospital accepts my insurance; presumably I already knew this or certainly assumed as much. What nobody tells me is that the physicin is actully employed by a third party who may or may not have a reimbursement agreement with my insurer, which leaves me exposed to any charges the third party imposes for the physician's services. This is astonishing and I am confident those charges are uncollectible on the basis of consumer fraud. If the hospital represents itself as under contract with my insurer, I should be entitled to assume that ER services are included.
131
Many practices that would be fraud or borderline fraud in other markets are not fraud in the medical/insurance industry because the market had become accustomed to accept them as normal.
8
"should be" and "assumed" are the key words. You are not entitled to anything legally, except emergency care to stabilize your condition only to the point that you can be safely transferred to another hospital for your care. That is all the hospital is legally obligated to provide.
The patient--the consumer--has no legal authority to tell the hospital how to conduct or manage its business. And it is a business, even the non-profits. The only legal option the patient has is to not "do business" with the hospital; which, of course, an unconscious or injured patient cannot choose to do. It's why the delivery of healthcare cannot be a consumer-driven market; but the rest of the US economy is.
The patient--the consumer--has no legal authority to tell the hospital how to conduct or manage its business. And it is a business, even the non-profits. The only legal option the patient has is to not "do business" with the hospital; which, of course, an unconscious or injured patient cannot choose to do. It's why the delivery of healthcare cannot be a consumer-driven market; but the rest of the US economy is.
3
There is often some fine print in the admission document you sign, or sometimes posted in the wall in the admission clerk's office, to the effect that many of the physicians and other professionals practicing in the hospital are independent contractors who will bill you separately for their services. Not that that does you a whole lot of good when you are bleeding or in pain and may not even know what type of treatment you need.
5
Is anyone surprised? We hardly need a Yale study to inform that a monopoly provider (EmCare) for professional ER services at a particular hospital will maximize revenue by refusing to participate in insurer networks (20% of all ER professional groups do likewise, according to the article) and upcoding..... This is just one small example of the lack of market forces in health delivery that results in enormous price increases in non-governmental financed services. The multi-billion/year, "not for profit" health system cartels (a/k/a your community health system) reward their execs millions in bonuses for consolidation, acquiring physician practices, adding a new "facility overhead" charge after acquiring the practices, raising prices to private insurers, then channeling all diagnostic testing and procedures to the much higher priced, cartel owned facilities. So what else is new? Medicare and Medicaid dictate prices for all services, including ER professional. Then the professional group will "cost shift" to private insurers. That's how the racket works. That is why only price controls or a sole payer system will curb ever spiraling private health service prices in the US. The only real surprise is why US employers, who end up paying a disproportionate share of US health costs (which make them non-competitive internationally) tolerate the racket.
46
This is the real problem with our healthcare system, but no one will acknowledge it.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Tren...
Costs of physicians and hospitals make up the vast majority of our healthcare costs (up to 80%) but these are the costs people complain about the least. While everyone is railing against the drug companies (only 10% of costs), no one is saying what is obvious: our current fee-for-service system is a sham.
Of course doctors and hospitals are going to order more tests. They get paid more if they do! More services = more fees!
Of course hospitals are going to hire companies to run their ERs (and any other department they can). When every single thing a doctor or nurse does ("service") is coded individually so it can be charged individually ("fee"), billing is a nightmare. Good, large hospitals put up with the nightmare and negotiate rates with insurers because they can, but a small, regional hospital would much rather hand the whole thing over to EmCare and let the patients suffer the consequences.
Companies like EmCare thrive because this fee-for-service system creates perverse incentives for hospitals and doctors to gouge patients. Hospitals should move permanently to transparent "diagnosis related" billing and all doctors should be salaried. Time to take away the incentives to over-charge and the excuses about overly complicated billing.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Tren...
Costs of physicians and hospitals make up the vast majority of our healthcare costs (up to 80%) but these are the costs people complain about the least. While everyone is railing against the drug companies (only 10% of costs), no one is saying what is obvious: our current fee-for-service system is a sham.
Of course doctors and hospitals are going to order more tests. They get paid more if they do! More services = more fees!
Of course hospitals are going to hire companies to run their ERs (and any other department they can). When every single thing a doctor or nurse does ("service") is coded individually so it can be charged individually ("fee"), billing is a nightmare. Good, large hospitals put up with the nightmare and negotiate rates with insurers because they can, but a small, regional hospital would much rather hand the whole thing over to EmCare and let the patients suffer the consequences.
Companies like EmCare thrive because this fee-for-service system creates perverse incentives for hospitals and doctors to gouge patients. Hospitals should move permanently to transparent "diagnosis related" billing and all doctors should be salaried. Time to take away the incentives to over-charge and the excuses about overly complicated billing.
18
Doctors caring for patients account for less than 10% of the medical industry's revenue. Your 'upto 80%' is misleading to say the least. Of course, there are doctor-administrators and doctor-managers in hospitals, insurers, and medical groups, possibly even in Emcare.
It is the "in-network/out of network" that is crazy. We need single payer, in which ALL doctors are "in-network" and doctors are not permitted to practice if they don't participate, as many do with medicare and medicaid now. Dentists, too.
35
So Stalinists now dream of compelling doctors to participate in collectivist farms, or not work. Instead of breaking up crony capitalist cartels and letting small physician groups thrive again, which will reduce prices due to competition among them.
1
Oh please. Health care has never been transparent, and price reductions because of "competition" will never happen. It is very hard to price shop health care procedures. All the OECD countries have some form of universal health care or insurance, spend way less money as a percent of GDP with better outcomes. Is there something wrong with that? Can we learn nothing from those other countries?
'Fiona Scott Morton, a professor at the Yale School of Management and a co-author of the paper, described the strategy as a “kind of ambushing of patients.”'
----
I would simply describe EmCare's practices as racketeering; obtaining or extorting money illegally or carrying on illegal business activities, usually by Organized Crime.
These practices and the entire American medical extortion industry need to be fully investigated and prosecuted under the Racketeer Influenced and Corrupt Organizations (RICO) law.
----
I would simply describe EmCare's practices as racketeering; obtaining or extorting money illegally or carrying on illegal business activities, usually by Organized Crime.
These practices and the entire American medical extortion industry need to be fully investigated and prosecuted under the Racketeer Influenced and Corrupt Organizations (RICO) law.
386
Socrates, the entire wealth care industry but most especially the "health insurance" industry practices extortion and ought to be prosecuted under RICO. I've been ambush billed by doctors which makes me think thrice before picking up the phone to see any doctor for any reason. Yet our politicians, cowards that they are, especially the GOP practicing sect of politicians, can't wait to pass legislation making our wealth care system even wealthier. It's the same thing that happened after Gabrielle Giffords was shot and that class of first graders in Newtown, CT: make guns more available to help the NRA and the firearms industry. Here, even as they get shot and need extensive surgery or have a serious illness diagnosed, they still want to give more money to the wealth care industry.
What is most obvious is that THEY have no idea of the cost of medical care or the cost of going without. They should be put on a diet of high deductible, high co-pay, narrow network, and unresponsive medical care. Then we'll see how fast things change once they have to live like the peasants they so despise.
What is most obvious is that THEY have no idea of the cost of medical care or the cost of going without. They should be put on a diet of high deductible, high co-pay, narrow network, and unresponsive medical care. Then we'll see how fast things change once they have to live like the peasants they so despise.
7
Problem is -- these activities are not illegal. Immoral and unethical to do this to patients--do those terms mean anything today--definitely. But they are not illegal. The only thing possibly actionable is intent to defraud insurance companies or the government (the Medi's) by up-coding on billing. Try to disprove an up-code in an ER!
3
Socrates,
You regularly pontificate on how great ACA is. It would be nice if you would acknowledge that ACA simply helps perpetuate a broken system. EmCare's practices aren't the disease, they are the symptom, and you don't have to look far to see abuses this bad, and worse, that will inevitably flourish in a for-profit, private health care system that is really more anything-goes than any kind of system.
Medicare for everyone.
You regularly pontificate on how great ACA is. It would be nice if you would acknowledge that ACA simply helps perpetuate a broken system. EmCare's practices aren't the disease, they are the symptom, and you don't have to look far to see abuses this bad, and worse, that will inevitably flourish in a for-profit, private health care system that is really more anything-goes than any kind of system.
Medicare for everyone.
1
Well. The marketplace works, y'all, and this is just one example of how fully the healthcare industry participates. I don't recall specifics, but does anyone remember the rise in 'Epipen' costs? Again, just another example of the marketplace at work.
i repeat what I have said on other occasions: I worked in a company with offices in over 120 countries, including all of western Europe. My department rotated personnel from those countries, and Japan, in for two-year stints with us. To a person, they were bewildered by the American healthcare 'system.' All of them thought it as quaint and inefficient at best, and inefficient and absurdly costly at worst.
Posted comments about laws that should be passed are laughable. By this legislature? With this president? I hope the Democrats are collecting these stories for 2018 and 2020, and will use them in the states where they took place. And remind us, nationally, about what can happen in the great marketplace.
Single-payer, where are you?
i repeat what I have said on other occasions: I worked in a company with offices in over 120 countries, including all of western Europe. My department rotated personnel from those countries, and Japan, in for two-year stints with us. To a person, they were bewildered by the American healthcare 'system.' All of them thought it as quaint and inefficient at best, and inefficient and absurdly costly at worst.
Posted comments about laws that should be passed are laughable. By this legislature? With this president? I hope the Democrats are collecting these stories for 2018 and 2020, and will use them in the states where they took place. And remind us, nationally, about what can happen in the great marketplace.
Single-payer, where are you?
182
Medicare for everyone may be closer than we all think. Really, it's inevitable. We simply can't keep going on like this, and the current clown show in Washington likely will only speed us to the inevitable as more and more people see the obvious: This emperor has no clothes.
I fully agree. But don't count on the Democrats for help. Democrat (and socialist) Bernie Sanders proposed an alternative, and was dismissed as a unicorn. Candidate Obama promised a "public option" with Obamacare, and dropped it like a hot potato when K Street objected, which is why the ACA is like a house with termites.
Greg Mendel, I know this will sound very strange to you, but I can absolutely favor tax-funded universal coverage, preferably Medicare for all, WITHOUT necessarily favoring Bernie Sanders or any other individual politician. Lots of people have proposed it, dating back to Teddy Roosevelt, but no one, not even Bernie Sanders, has ever come up with a realistic political strategy for getting such a plan passed through both houses of Congress. I agree with Bernie, but he has no more power to accomplish that goal than I do, and no strategy for winning over Congress. Sorry. The idea is not synonymous with one man. Seeing it that way is a distraction from the long game -- the game Obma was playing when he enacted an ACA that provides benefits now precious even to many voters who opposed him.
The article states the EmCare is a 'staffing agency'. One assumes that they are receiving salary, benefits, and other compensation for their services from EmCare.
Why, then, are they also billing patients directly? This is pure double billing. The patients and their insurers pay hospitals for the services the patients receive; the Hospitals pay EmCare who pays the doctors.
Then the doctors who have already been paid for their services are allowed to bill the patients directly, patients who have already paid for the services they have received.
HOW IS THIS LEGAL?
Why, then, are they also billing patients directly? This is pure double billing. The patients and their insurers pay hospitals for the services the patients receive; the Hospitals pay EmCare who pays the doctors.
Then the doctors who have already been paid for their services are allowed to bill the patients directly, patients who have already paid for the services they have received.
HOW IS THIS LEGAL?
38
There are two parts for any in-patient claim, professional and facility. Hospitals more often than not these days don't employ their own physicians, they contract to a physician group ("staffing agency") to staff their departments.
Physician groups make their revenue billing for their services, the money they make from a contract with the hospital (if any) is peanuts.
Physician groups make their revenue billing for their services, the money they make from a contract with the hospital (if any) is peanuts.
1
EmCare pays the doctor. The contract is between EmCare and the hospital. The hospital doesn't bill for the doctor; EmCare bills as a service for its doctors, with the doctor's name on the bill. It's like in a legal or accounting firm. Very common practice in professional staffing and very legal.
2
the company bills in the dictors name and collects the fee. medicare pays the facility and doctors separetly ny lae
2
End the medical extortion: Medicare for all.
253
It's the only way, but the citizens of the US must be willing--eager--to pay a lot more than current Medicare costs in taxes. They have been slowly reaching this point over the last 20 years -- almost there!
2
F. Horne
Get a Democratic Congress and that might happen.
MIMA
Get a Democratic Congress and that might happen.
MIMA
1
What would we pay for a car if we had to buy it from a transportation insurance company? We arrest bank robbers. But if they're wearing a white work jacket we don't? This country is so, so bought and sold. It cannot, and will not go on much longer. It is absolutely unsustainable.
28
There should be a law if there is no choice of a network provider, no surcharge. We are talking ER rooms not elective surgery. It not in a network the insurance contract prices which are much lower than the list price do not apply.
Perhaps patients should be given the same generous cut Insurance Companies get. Your $2000 bill is a $1200 bill to the Insurance Company,
Perhaps patients should be given the same generous cut Insurance Companies get. Your $2000 bill is a $1200 bill to the Insurance Company,
20
My relative had to go an Emergency room, spent 20 min there, they did an EKG. As EKG was normal, we got out from there very fast even though they wanted to do additional tests). Bill was only around 5000 dollars for an EKG. How can we allow these kinds of highway robbery to go on. No wonder our healthcare system will bankrupt the patients and our country. This must be stopped.
79
Are you willing to pay a lot more in income taxes to have another healthcare system? It's what other countries do.
5
In a word, yes. I. Am.
5
Citizen60:
Yes I'm willing to pay more in taxes. I'm also willing to take funds from the military's toy budget to pay for single payer and improve this country's infrastructure.
Yes I'm willing to pay more in taxes. I'm also willing to take funds from the military's toy budget to pay for single payer and improve this country's infrastructure.
2
This is what happens whenever a monopoly is created. In the case of the ER, the physician group that holds the contract has a virtual monopoly on the delivery of care. They have an incentive not to sign a contract with an insurance group. Why should they when they have the ability to bill any amount they want. The reasoning that Emcare "allowed a hospital to treat sicker patients" or that "it's a source of dissatisfaction for all...providers" is again just lip service to justify their gaming the system.
A hospital has a certain level of service it is certified to provide in it's ER. Unless each of the Emcare hospitals changed the level of service from a trauma level center 1, 2 or 3, the service levels are defined. There are ways to manipulate the billing which larger companies have the manpower to do.
And why would it be a source of dissatisfaction? When the median ER physician is making almost $300,000 per year, they are not being incentivized to lower costs. Instead, if they would rather control the market, i.e. Your only choice when you go to the ER, sign no contracts with the local insurers and bill what they can get away with
A hospital has a certain level of service it is certified to provide in it's ER. Unless each of the Emcare hospitals changed the level of service from a trauma level center 1, 2 or 3, the service levels are defined. There are ways to manipulate the billing which larger companies have the manpower to do.
And why would it be a source of dissatisfaction? When the median ER physician is making almost $300,000 per year, they are not being incentivized to lower costs. Instead, if they would rather control the market, i.e. Your only choice when you go to the ER, sign no contracts with the local insurers and bill what they can get away with
24
Or you can scratch out the portion of the form that says you will be personally responsible for the charges if your insurance company does not pay, and initial the change. Then sign the form. They still have to finish the emergency care being provided. The only time this doesn't work is for the unconscious patient.
2
In just about any business, when your vendor farms something out it is on them to pay the contractor not the end customer. For example, if you take your car to an auto repair shop, you expect to pay the shop, not receive bills from individual mechanics.
This is an element of the health care system that needs strong consumer legal protections. If the hospital makes the decision to contract out labor, then the hospital should be on the hook for paying those contractors out of the money it bills to the patient or their insurance company.
The behavior described in the article is nothing more than a bait-and-switch tactic.
This is an element of the health care system that needs strong consumer legal protections. If the hospital makes the decision to contract out labor, then the hospital should be on the hook for paying those contractors out of the money it bills to the patient or their insurance company.
The behavior described in the article is nothing more than a bait-and-switch tactic.
92
That's exactly what it is, and why it's only found in specialities the patient have no choice whatsoever over--emergency, anesthesiology, and radiology. The hospitals will find more niche, specific service providers if they can--highly profitable for them and the companies.
2
Wonderful analogy! Of course, any auto repair shop that did that would be out of business in a flash. Hospitals, on the other hand, have a monopoly on treatment so they don't have to abide by the same rules.
2
The only surprise is that some people are (still) surprised by these findings.
26
AH HA! Yes the costs are due to the out of control bills based on mythical "codes" and uncontrolled drug costs. Yes, we know this and so do the politicians but 1000 lobbyists working each day and paying millions to keep the con going. 40% of procedures not necessary, drug prices, for same drug, can vary from $40 to $400 in same city. MRI can vary from $2000 to $6000 for same exam. Visit to ER for a headache can cost $3000. Yes we are being robbed and the politicians could care less.
32
The politicians not only could care less but are paid off through contributors, pacs, etc. to protectant even further deregulate the scheme.
I can say with certainty that my congressfolk and senators are not looking out for the common good.
I can say with certainty that my congressfolk and senators are not looking out for the common good.
1
What you say is true, but please don't go to the ED for a headache!
2
I am constantly reminded of what Bernie Sanders said: "The business model of Wall Street is fraud."
77
True. But it's the business model that spurred the War for Independence, and is in our country's DNA. Bernie wants to change that DNA, and maybe the country is ready for a change.
Yes, working as designed, and very well, to extract money from the innocent.
Certainly not a problem confined to the ED, but the uniqueness of the ED's purpose makes it particularly troubling. Patients usually don't have time to "shop around" for emergency services and providers. It's almost like peeling an onion. My daughter was seen in a local ED about a year ago. $150 copay. But beyond that, a slew of bills from the lab, an out-of-state ER practice, among others. Fortunately, our insurance stepped in, but what if it hadn't for one or more of these providers?
19
If you don't pay-up within "x" days you get the collection agency on you as well. You don't even have time to argue the bill, your credit score gets lowered. Have to pay-up and fight later. From personal experience.
6
EmCare. Enron. It's all the same. American businesses are predatory and are mostly allowed to get away with it. When and if they do get caught, they pay a fine and move on. The potential fines are built into their business plan from the start.
172
"EmCare. Enron. It's all the same. American businesses are predatory and are mostly allowed to get away with it."
Most American businesses are not predatory. But we need a free press to call out the ones who are, and aggressive prosecutors to drive them out. Otherwise the magic of the unregulated free market will do the opposite and drive the honest ones out, and your statement will be true. In the meantime, it's vital to draw a bright line between the honest and the corrupt, and do what we can to support the former and shame and boycott the latter.
Most American businesses are not predatory. But we need a free press to call out the ones who are, and aggressive prosecutors to drive them out. Otherwise the magic of the unregulated free market will do the opposite and drive the honest ones out, and your statement will be true. In the meantime, it's vital to draw a bright line between the honest and the corrupt, and do what we can to support the former and shame and boycott the latter.
1
This is organized crime. These physicians are part of a fraud and should be prosecuted under the RICO act.
133
Yeah but can you imagine if we had SOCIALISM and all of these people's bills were paid for? Then who would profit off their misfortune?!?! So un-American. #sad
60
The point is healthcare is cut, first to give more profits to the healthcare industry and now as an attempt to reward donors, who control the government. This does not mean people won't get sick. On a median income of around $30,000 they can't afford this bloated system. So when they do show up very ill what will happen? Back to the ER until that becomes too expensive or the GOP does away with that option. OMG, now what do we do? Die?
7
The private, largely unregulated medical system has crossed the point of no return for abuse and exploitation. They deserve what's coming to them, which will be some form of single payer or a highly regulated federalized system (like Germany has). The endless gotchas and landmines for consumers in this systematically corrupt business will never come to an end without strong, pervasive government regulation. We cannot keep spending more than twice what all our peer countries spend per capita and be an economically competitive country. Heck, our life expectancy is down to #31 in the world, just ahead of Cuba at #32; Canada and Australia, the two countries who are closest to us economically and culturally live a stunning 3 years longer on average.
118
It has nothing to do with healthcare systems: Canadians and Australians "live longer" because they are vastly majority white/asian -- asians naturally live somewhat longer than other racial groups.
The US has a very large underclass of poor blacks and hispanics, who both historically and genetically have more health problems, and shorter lifespans.
If you compare "only white middle class Americans" with "only white middle class Canadians, Australians or Europeans" --- we do just as well and even better sometimes.
The US has a very large underclass of poor blacks and hispanics, who both historically and genetically have more health problems, and shorter lifespans.
If you compare "only white middle class Americans" with "only white middle class Canadians, Australians or Europeans" --- we do just as well and even better sometimes.
There is no logical reason why a hospital or a physician should be entitled to bill one patient 4x or more what it bills another for the same service. This is another example of the scams that have grown up in the U.S.'s medical billing system, and go on because medical providers are simply charging the maximum they can get away with. The root problem is perverse incentives. In our third-party payment system, everybody involved has the incentive to raise prices to the hilt and hardly anyone has any incentive, or knowledge, or tools, to exercise cost and billing control. This is the fundamental reason U.S. medical costs have ballooned, and compare so unfavorably to other countries that have not made the same mistake. Strong regulation could help, but it will never happen with Congress in the palm of big-money medical industry donors. We all need to agitate to jump straight to some version of single payer, like every other developed country; it is the only cure for this disease.
197
Here's a logical reason-most ER patients do not pay their bills. That's what happens when you have a place that is open 24 hrs and must provide care to every single patient who walks through the doors, regardless of their ability to pay. Those who can and do pay are essentially subsidizing the care of those who can't or won't. I had a patient during residency who racked up over $500,000 in during her 2 week stay, which was caused by her alcohol abuse leading to withdrawal that required intubation, ventilation, and intensive care. She used up an exorbitant amount of healthcare resources, and won't ever end up paying a cent. Who gets stuck with those costs? Everyone else who works and pays for their insurance through our increased premiums.
1
Most developed countries have a hybrid payer system, not single payer. What you are referring to is universal coverage, which IS NOT necessarily single payer. And most of those countries with universal coverage and hybrid payer systems have better health outcomes than the UK, which has equally poor outcomes as the US.
1
Thank you for bringing to light on of the most pernicious, unethical problems that patients face. This is not confined to ED services.This occurs in massive amounts in offices and clinics throughout the USA. The underlying problem is that patients are not informed of the potential costs, they are not given a choice of potential providers who do take their coverage, and last (but not least) the electronic medical record makes it so easy to bill for service never rendered. Just a click of the mouse allows the MD to bill at a level 4 visit for the simple ankle sprain. Many hospitals are complicit in this fraud.They know it goes on but excuse themselves from responsibility by saying, "Physician billing is not our business." Turning a blind eye is evil. No wonder we are going broke.
54
If a level four is supposed to take, say a 1/2 hour, and overseer added up the level 4 time periods billed each day, and it was more than the time given the patients in that whole day, and there was repercussion for such billing, it would stop. Why is this not one of the quality measures EMR's are checking? This might actually be valuable, as compared to a lot of others.
2
I asked the very same question. There was no interest in looking at this. Most EMRs use inventive billing as a way to increase revenue increased revenue as a selling point, not as a way to monitor for ethical practice. Plus nobody wants to admit it is going on
1
There is a cure for this problem if our politicians have the courage to enact it. Simply pass a law stating that "no hospital, physician or other medical care provider participating Medicare or Medicaid shall charge more than 150% of the Medicare-allowed amount for any service or procedure." Since Medicare/Medicaid payments represent over 50% of the typical hospital's revenue, no hospital would sign a contract with the groups who prey on out-of-network patients and/or charge exorbitant fees. The 150% payment level is generous and exceeds almost all insurers' reimbursements. They would, as they should, quickly go extinct.
15
lets do the same with lawyers. their fee across the country at 150% the federal rate.
3
Well then, let's do it for all professions. We could define what is fair payment for everything, from plumbers to movie stars (and including columnists), and allow little leeway in pay range.
1
"Insurers and health care providers typically sign contracts forbidding them to reveal the prices they have agreed to"
Just mandate the opposite this in the next version of GOP/Trump-care and healthcare will be fixed.
Just mandate the opposite this in the next version of GOP/Trump-care and healthcare will be fixed.
9
Stark laws, check them out. To stop doctors from unionizing or comparing prices with each other.
3
How can we find out if our local hospitals use this company? Are they compelled to tell us if we call them and ask the question?
28
Just curious--did EmCare facilities see a jump in positive outcomes? I am not a fan of health care providers gouging their patients, but on the other hand, one way to maintain low costs is to hold care down. This article seems unbalanced to me.
1
I'd bet my life they did not. This is about taking money from the vulnerable, not quality of care.
17
Many studies have shown no relationship between cost and outcomes. Read Elisabeth Rosenthal's series Paying Till It Hurts that ran in this newspaper several years ago.
3
In France there are no insurance company discounts and no out of network providers. The providers charge the same fee for the same service to all patients. There is a better and fairer way.
437
France never had the health care industry that America does. Do you think the American healthcare industry is going to accept making the same amount of money across the board?
I think everyone needs a dose of reality when it comes to understanding why Single Payer will never happen in America.
I think everyone needs a dose of reality when it comes to understanding why Single Payer will never happen in America.
1
I was recently in Paris and had to go to the emergency room. Being American, I had to pay out of pocket. The total cost for two ambulance rides (to the hospital and back) and an exam by a physician came to a little over a $100.
It's a travesty that health care is so expensive in the USA.
It's a travesty that health care is so expensive in the USA.
7
Considering how large a percentage of people needing emergency care are elderly, I think this article should have at least mentioned whether or not EmCare accepts Medicare rates.
18
I serve on my community hospitals' Community Quality Council. The hospital administrator serves on this committee in addition to others in management. Trust me, Em Care will be a topic of conversation and discussion at our next meeting. The community public deserves to know if their hospital uses these services (which I don't think ours does) and deserves to know why if they do and other details.
Wondering if down the road the next story about EmCare will be about fraud.
Wondering if down the road the next story about EmCare will be about fraud.
76
It is against EmCare's deeply religious principles to charge low fees. It is against the GOPs deeply held religious beliefs to not allow gouging of people who have no choice.
It is a first amendment thing, you know. You guys aren't against the Constintution, are ya?
It is a first amendment thing, you know. You guys aren't against the Constintution, are ya?
14
What is the difference between EM Care and La Cosa Nostra? Why are our prosecutors, regulators and politicians going after them under racketeering rather then preying upon poor people with limited resources.
24
Yes the Republicans and their organs are all about sneaky people being able to make a huge amount of money for doing nothing that contributes to a positive outcome - i.e. - health insurers and money managers. These are big areas that are contrived, unnecessary, and must be brought to heel or put out of existence.
26
I own a healthcare advocacy, and we are infuriated on a regular basis by mystery billing. EmCare is deliberate and intentional in its efforts to defraud unsuspecting patients, as are many providers, insurers and manufacturers within the healthcare space.
How do they get away with it? Just ask our Congress and Administration.
Get a $1200 ER bill? Don't look to your insurer to help you. Sure, they've negotiated costs with the hospital but will not step in when you're price gouged by the EmCares and hospital groups. You either pay, fight, or damage your credit. We overpay an estimated $58 billion a year in medical debt we don't owe.
Need a cure for Hep C? Shell out close to $100,000 here because your insurer won't cover it, hope for a new liver or go to India and pay $400 for the same treatment. Our government does nothing to control outrageous pharmaceutical and device costs. We basically bankroll the rest of the world.
Denied a claim by your insurance company that should be covered? Federal and state insurance agencies are nothing more than paper tigers. If you appeal your denial, you'll get what you should have received in the first place 56% of the time when the insurer overturns its own denial.
50% - 80% of all medical bills contain errors. Chances are, you'll get stuck paying what you don't owe. The government doesn't do anything to stop this fraud.
Instead, Congress tries to pass a tax cut for the rich disguised as healthcare reform. Disgusting.
How do they get away with it? Just ask our Congress and Administration.
Get a $1200 ER bill? Don't look to your insurer to help you. Sure, they've negotiated costs with the hospital but will not step in when you're price gouged by the EmCares and hospital groups. You either pay, fight, or damage your credit. We overpay an estimated $58 billion a year in medical debt we don't owe.
Need a cure for Hep C? Shell out close to $100,000 here because your insurer won't cover it, hope for a new liver or go to India and pay $400 for the same treatment. Our government does nothing to control outrageous pharmaceutical and device costs. We basically bankroll the rest of the world.
Denied a claim by your insurance company that should be covered? Federal and state insurance agencies are nothing more than paper tigers. If you appeal your denial, you'll get what you should have received in the first place 56% of the time when the insurer overturns its own denial.
50% - 80% of all medical bills contain errors. Chances are, you'll get stuck paying what you don't owe. The government doesn't do anything to stop this fraud.
Instead, Congress tries to pass a tax cut for the rich disguised as healthcare reform. Disgusting.
636
Sarah,
I'm curious what your medical background is.
MIMA
I'm curious what your medical background is.
MIMA
You are right about the insurance company not helping fight these outrageous charges. Even for in-network charges, all the insurance company will do is reduce billed charges to negotiated charges and send you the bill for deductible. If you point out the duplicate charges or strange items on the bill, they won't help as long as the total is within your deductible.
Thank you for this enlightening article and Ms O leary thank you for your spot on comment. Trying to fight the Insurance company "Paper Tiger" and provider's billing is indeed exhausting. How folks dealing with illness, financial stress ,and the normal work/ family life is beyond me. Endless phone calls will get you no where. It is time and productivity wasted for everyone. Ive finally decided to call my local senator for help navigating the maze of trouble in resolving issues. Lets get rid of the for profit
publicly traded model of healthcare. Understandably, providers need to earn a living but we have runaway greed happening. Lets hope the pendulum is swinging toward single payer.
publicly traded model of healthcare. Understandably, providers need to earn a living but we have runaway greed happening. Lets hope the pendulum is swinging toward single payer.
4
Profits? Lot's of bills for NOTHING! The GOP does't like Workman's Compensation. When I was injured at work, there were bills from doctors I never saw. I reported it to my Union and company, and lot's of bills got dropped. Scamming by medical companies and doctors is epidemic.
105
The general public would probably be surprised if they realized how much in ourhealth care system is based on revenue generation relative to how much is based on what actually works.
52
What is wrong with hospital administrators? If you can't run your ER economically, what in the world would make you think that by adding a profit driven middleman, it's going to run at lower cost? It won't. It will run at a higher cost, and since the middle man is profit driven, they will charge the patients as much as they think they can get away with.
The solution is to keep the ER operations in house, and offer salaries for staff sufficient to attract the staff you need, and adjust your non-profit-driven costs accordingly. People may not be happy with the resulting modest bill increase, but it won't be the 3.5 times increase cited in this article.
The solution is to keep the ER operations in house, and offer salaries for staff sufficient to attract the staff you need, and adjust your non-profit-driven costs accordingly. People may not be happy with the resulting modest bill increase, but it won't be the 3.5 times increase cited in this article.
216
Tyrone,
As someone who has recruited physicians, there is an acute shortage of doctors in the US. There are not enough doctors to fill the needs so companies are forced to hire outside firms to staff their ER because they can't find enough local doctors to do it. It's not as simple as just keeping in in-house. If they could, they would.
As someone who has recruited physicians, there is an acute shortage of doctors in the US. There are not enough doctors to fill the needs so companies are forced to hire outside firms to staff their ER because they can't find enough local doctors to do it. It's not as simple as just keeping in in-house. If they could, they would.
1
When you contract out to physician groups you don't pay their salaries, they get paid off reimbursements from claims and you no longer have to pay for administrative overhead (HR, billing/coding, quality programs, etc.)
I work for a medical billing company owned by a physician group, I'm a software developer making a living like everyone else, but I genuinely believe our physicians provide top-notch care while saving both the hospital and patients money. We contract with many insurance networks, have strict quality programs for both our physicians and our billing/coding personnel to ensure patients are cared for and we bill appropriately - we even get higher reimbursement rates from Medicare due to our performance in quality measures and reporting. We even have financial hardship guidelines working on sliding income scales to help un/underinsured patients who can't afford a huge physician bill and give patients information on enrolling in Medicaid if they seem to qualify, you can't get milk from a rock so it's both in our best interest and the interest of the patient to try to make the best of the situation rather than saying "here's your bill, now pay up".
Of course, I can only speak for my employer - physician staffing is a competitive field, but there ARE groups and billing companies out there who do it ethically and try to balance the needs of all parties involved.
I work for a medical billing company owned by a physician group, I'm a software developer making a living like everyone else, but I genuinely believe our physicians provide top-notch care while saving both the hospital and patients money. We contract with many insurance networks, have strict quality programs for both our physicians and our billing/coding personnel to ensure patients are cared for and we bill appropriately - we even get higher reimbursement rates from Medicare due to our performance in quality measures and reporting. We even have financial hardship guidelines working on sliding income scales to help un/underinsured patients who can't afford a huge physician bill and give patients information on enrolling in Medicaid if they seem to qualify, you can't get milk from a rock so it's both in our best interest and the interest of the patient to try to make the best of the situation rather than saying "here's your bill, now pay up".
Of course, I can only speak for my employer - physician staffing is a competitive field, but there ARE groups and billing companies out there who do it ethically and try to balance the needs of all parties involved.
1
Anita,
So where are these outside firms getting their doctors from? If there is a shortage it has to be a zero-sum game.
Are all these doctors itinerant-staying in one place for a short-time? Are all these hospitals in rural/poor areas?
So where are these outside firms getting their doctors from? If there is a shortage it has to be a zero-sum game.
Are all these doctors itinerant-staying in one place for a short-time? Are all these hospitals in rural/poor areas?
2
This is why Republicans want smaller government: So that corporations can make obscene criminal profits and pay bribes for campaigns.
329
This is why DEMOCRATS don't want Single Payer or Medicare For All: So that corporations can make obscene criminal profits and pay bribes for campaigns. WAKE UP.
4
Greg Gerner, you need to wake up. You offer no facts to support your claims about Democrats. All the Democratic voters and politicians I know and support favor universal health care. A survey of nations with universal coverage will show there are multiple ways to achieve it. Medicare for All would be ONE excellent approach, but not necessarily the ONLY one. I am deeply grateful to the Democrats who passed the ACA, which (1) helped save my eyesight while I was self-employed; and (2) changed the conversation about health care in America by offering more protection to more Americans than ever before. Nothing happens instantly in a country as big and complicated as ours. Democrats want what you want; Republicans don't. It's that simple .No third party vote will accomplish it. So your choice is betweeen one possible and two impossibles. Me, I vote for the possible and push it my direction, over decades if necessary. You can throw up your hands in righteous disgust with that, and see how far it gets you.
4
That is exactly right. The American healthcare system IS the best in the world -- at extracting money. And that's the way a lot of people want it.
2
As a physician with 35 years under my belt and with over 5 years of ER experience before going into primary care, all I can say is that this is as appalling as it is predictable. For profit, unregulated "market based" health care will ALWAYS result in these sorts of systemic corporate abuses. There is a simple solution: SINGLE PAYER.
836
Single payer has some benefits, but it would not change this. Single payer does not mean that medical providers cannot charge as much as they want.
3
An established benefit/program is already in place: Medicare. Medicare operates at a lower cost than private insurers; it has excellent record keeping; coverage is universal and regulated. Truman had to fight to get Medicare in place; now we have it and should expand it to cover all Americans citizens, no age barriers. If that is socialized medicine, what is Social Security? European countries have universal care; the current problem they have is coming from the mass migration of poor from war torn and drought impacted countries. Their health care systems were never designed to accommodate the world's population.
6
Yes. FOR PROFIT. Not for care. Or, you'll get the most expensive care they can give you because they can make more profit. Or, they will cut corners somewhere (everywhere?) because...more profit. The first, or ONLY, concern of a for-profit company is more profit. Everything else is secondary.
Your health? Secondary. Your well-being? Secondary. Your financial ability to pay or afford care? Secondary.
What is the primary concern? MORE PROFIT.
Your health? Secondary. Your well-being? Secondary. Your financial ability to pay or afford care? Secondary.
What is the primary concern? MORE PROFIT.
5
I live in a rural area in Arkansas and have had multiple parishioners in my church suffer this sticker shock. Hospital is in network, ambulance covered, tests covered, but the ER doctor is out of network. Many of these persons do not have the resources to pay these heightened bills.
97
The Governor of Florida was head of a hospital corporation that over billed the government for billions of dollars of Medicare bills. In the republican party, where every businessman is "Jesus Christ businessman", there is only blind trust by their voters. Anyway the healthcare system seems ripe for privatizing so no one ever gets health care and republicans only reap profits. Looks like a win win to me!
108
This is just the tip of the iceberg. Keep investigating medical billing practices and you will find many abuses, not only in emergency care, but in hospital billing and in the billing practices of individual and groups of physicians.
341
Please, please keep investigating as possibly suggested. Even from outside the US the healthcare system seems unacceptable both in terms of the comparative costs and in terms of the comparative outcomes. This is not the America I used to think I knew.
14
Famdoc,
Former NYT writer Elisabeth Rosenthal has largely already done this in a story published last spring:
https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical...
Anyone who isn't spitting mad after reading this either doesn't have a pulse or is one of the greed mongers profiting from runaway costs with no effective checks or balances.
Medicare for everyone.
Former NYT writer Elisabeth Rosenthal has largely already done this in a story published last spring:
https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical...
Anyone who isn't spitting mad after reading this either doesn't have a pulse or is one of the greed mongers profiting from runaway costs with no effective checks or balances.
Medicare for everyone.
5